Provider Demographics
NPI:1417510694
Name:SONG, JOYCE (DO)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:SONG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 CITRACADO PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-6428
Mailing Address - Country:US
Mailing Address - Phone:760-746-2641
Mailing Address - Fax:
Practice Address - Street 1:625 CITRACADO PKWY STE 200
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-6428
Practice Address - Country:US
Practice Address - Phone:760-746-2641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10828208000000X
CA20A20032208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics