Provider Demographics
NPI:1598951584
Name:SONG, LUCIAN HYOSUK (MSW)
Entity Type:Individual
Prefix:MR
First Name:LUCIAN
Middle Name:HYOSUK
Last Name:SONG
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11080 W OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1937
Mailing Address - Country:US
Mailing Address - Phone:310-966-6500
Mailing Address - Fax:
Practice Address - Street 1:11080 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064
Practice Address - Country:US
Practice Address - Phone:310-966-6668
Practice Address - Fax:310-966-9473
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2007-11-21
Deactivation Date:2007-10-22
Deactivation Code:
Reactivation Date:2007-11-21
Provider Licenses
StateLicense IDTaxonomies
CA217981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical