Provider Demographics
NPI:1467133470
Name:SONG, SAEUN (DACM)
Entity Type:Individual
Prefix:
First Name:SAEUN
Middle Name:
Last Name:SONG
Suffix:
Gender:M
Credentials:DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 POINTE DR
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3600
Mailing Address - Country:US
Mailing Address - Phone:213-842-3566
Mailing Address - Fax:
Practice Address - Street 1:430 POINTE DR
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3600
Practice Address - Country:US
Practice Address - Phone:213-842-3566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19823171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist