Provider Demographics
NPI:1619155041
Name:JOSEPH K. SONG, M.D., INC
Entity Type:Organization
Organization Name:JOSEPH K. SONG, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:K
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-902-7700
Mailing Address - Street 1:16262 WHITTIER BLVD STE 21
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2904
Mailing Address - Country:US
Mailing Address - Phone:562-902-7700
Mailing Address - Fax:562-902-7704
Practice Address - Street 1:16262 WHITTIER BLVD STE 21
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2904
Practice Address - Country:US
Practice Address - Phone:562-902-7700
Practice Address - Fax:562-902-7704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69832207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G698320Medicaid
CA00G698320Medicaid