Provider Demographics
NPI:1457640914
Name:SONG, TARA ELENA (MD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:ELENA
Last Name:SONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 WOODMAN AVE
Mailing Address - Street 2:DEPT OF HEAD AND NECK SURGERY
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402
Mailing Address - Country:US
Mailing Address - Phone:303-324-4690
Mailing Address - Fax:
Practice Address - Street 1:8110 WOODMAN AVE
Practice Address - Street 2:DEPT OF HEAD AND NECK SURGERY
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402
Practice Address - Country:US
Practice Address - Phone:818-375-2732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA125132207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology