Provider Demographics
NPI:1629031927
Name:SONG, JIN WOO (DMD)
Entity Type:Individual
Prefix:DR
First Name:JIN WOO
Middle Name:
Last Name:SONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:JIN
Other - Last Name:SONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:935 HIGHWAY 34
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747
Mailing Address - Country:US
Mailing Address - Phone:732-970-8184
Mailing Address - Fax:732-970-8187
Practice Address - Street 1:935 HIGHWAY 34
Practice Address - Street 2:SUITE 2C
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747
Practice Address - Country:US
Practice Address - Phone:732-970-8184
Practice Address - Fax:732-970-8187
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225511223P0221X
NJ22DI022551001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry