Provider Demographics
NPI:1578677860
Name:SONG, SEUNG-YIL (MD)
Entity Type:Individual
Prefix:DR
First Name:SEUNG-YIL
Middle Name:
Last Name:SONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:S.Y.
Other - Middle Name:THOMAS
Other - Last Name:SONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7930 FROST ST STE 405
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2759
Mailing Address - Country:US
Mailing Address - Phone:858-571-2811
Mailing Address - Fax:858-571-2814
Practice Address - Street 1:7930 FROST ST STE 405
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2759
Practice Address - Country:US
Practice Address - Phone:858-571-2811
Practice Address - Fax:858-571-2814
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25278207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA953302834OtherTAX ID
CA00A252780Medicaid
CAA83223Medicare UPIN
CA00A252780Medicaid