Provider Demographics
NPI:1437689536
Name:SONG, DELU (MD)
Entity Type:Individual
Prefix:DR
First Name:DELU
Middle Name:
Last Name:SONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7695 CARDINAL CT STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-3357
Mailing Address - Country:US
Mailing Address - Phone:858-609-7100
Mailing Address - Fax:951-797-4333
Practice Address - Street 1:7695 CARDINAL CT STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-3357
Practice Address - Country:US
Practice Address - Phone:858-609-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA173049207WX0107X, 207W00000X, 207WX0107X, 208D00000X
CAMT213490207WX0107X
PAMT213490207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice