Provider Demographics
NPI:1275558868
Name:S & SONG INC
Entity Type:Organization
Organization Name:S & SONG INC
Other - Org Name:SOONOK K SONG
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOONOK
Authorized Official - Middle Name:KONG
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:CNS-PMM
Authorized Official - Phone:410-829-5148
Mailing Address - Street 1:4616 MORNING RIDE CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042
Mailing Address - Country:US
Mailing Address - Phone:410-461-4425
Mailing Address - Fax:410-462-3517
Practice Address - Street 1:4616 MORNING RIDE CT
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042
Practice Address - Country:US
Practice Address - Phone:410-829-5148
Practice Address - Fax:410-462-3517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR057717364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD54664301OtherBCBS
MD490108Medicare ID - Type Unspecified
S57736Medicare UPIN