Provider Demographics
NPI:1376872150
Name:SONG, HAN D
Entity Type:Individual
Prefix:MR
First Name:HAN
Middle Name:D
Last Name:SONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7004 LITTLE RIVER TPKE
Mailing Address - Street 2:SUITE F
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3201
Mailing Address - Country:US
Mailing Address - Phone:703-642-1900
Mailing Address - Fax:703-642-1919
Practice Address - Street 1:7004 LITTLE RIVER TNPK
Practice Address - Street 2:SUITE F
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003
Practice Address - Country:US
Practice Address - Phone:703-642-1900
Practice Address - Fax:703-642-1919
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000605171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist