Provider Demographics
NPI:1417454869
Name:SONG, HONGWOO (DO)
Entity Type:Individual
Prefix:DR
First Name:HONGWOO
Middle Name:
Last Name:SONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:866 S WESTMORELAND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-2372
Mailing Address - Country:US
Mailing Address - Phone:800-821-5675
Mailing Address - Fax:213-289-1166
Practice Address - Street 1:408 S BEACH BLVD STE 204
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-1878
Practice Address - Country:US
Practice Address - Phone:800-821-5675
Practice Address - Fax:714-484-3852
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA19661207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine