Provider Demographics
NPI:1376991745
Name:SONG, TARIM (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:TARIM
Middle Name:
Last Name:SONG
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6961 SE RED ALDER ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-2674
Mailing Address - Country:US
Mailing Address - Phone:847-224-2015
Mailing Address - Fax:
Practice Address - Street 1:5625 NE ELAM YOUNG PKWY STE 300
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6422
Practice Address - Country:US
Practice Address - Phone:503-924-2248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA651481223X0400X
ORD110161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORD11016OtherDENTAL LICENSE
CA65148OtherDENTAL LICENSE
CAFS5632294OtherDEA