Provider Demographics
NPI:1376657379
Name:KEN W. SONG, DDS, PS
Entity Type:Organization
Organization Name:KEN W. SONG, DDS, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-242-2881
Mailing Address - Street 1:14432 MILITARY RD S STE 3
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-5303
Mailing Address - Country:US
Mailing Address - Phone:206-242-2881
Mailing Address - Fax:206-242-2880
Practice Address - Street 1:14432 MILITARY RD S STE 3
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-5303
Practice Address - Country:US
Practice Address - Phone:206-242-2881
Practice Address - Fax:206-242-2880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7508122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty