Provider Demographics
NPI:1366645517
Name:JAMES Y SONG MD PHD PS
Entity Type:Organization
Organization Name:JAMES Y SONG MD PHD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-899-6226
Mailing Address - Street 1:1600 116TH AVE NE STE 302
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3057
Mailing Address - Country:US
Mailing Address - Phone:425-899-6226
Mailing Address - Fax:425-899-6220
Practice Address - Street 1:1600 116TH AVE NE STE 302
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3057
Practice Address - Country:US
Practice Address - Phone:425-899-6226
Practice Address - Fax:425-899-6220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038370174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8865420OtherMEDICARE LEGACY NUMBER
WAH15970Medicare UPIN