Provider Demographics
NPI:1518471366
Name:SONG, SUN YOUNG (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUN YOUNG
Middle Name:
Last Name:SONG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25033 SE 42ND ST
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-5791
Mailing Address - Country:US
Mailing Address - Phone:310-560-1166
Mailing Address - Fax:
Practice Address - Street 1:15165 NE 24TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5544
Practice Address - Country:US
Practice Address - Phone:425-562-2919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60790097122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist