Provider Demographics
NPI:1619198272
Name:SON, DENNIS HYUN (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:HYUN
Last Name:SON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5317 HERITAGE PL
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4986
Mailing Address - Country:US
Mailing Address - Phone:310-713-9601
Mailing Address - Fax:
Practice Address - Street 1:5317 HERITAGE PL
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4986
Practice Address - Country:US
Practice Address - Phone:310-713-9601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA830712085R0202X, 2085R0204X
NV124322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP00440886Medicare PIN
NV104634Medicare PIN