Provider Demographics
NPI:1629363908
Name:BYRON T SONG, M.D. INC
Entity Type:Organization
Organization Name:BYRON T SONG, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP. SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:626-963-1627
Mailing Address - Street 1:415 W CARROLL AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-4208
Mailing Address - Country:US
Mailing Address - Phone:626-963-1627
Mailing Address - Fax:626-963-0467
Practice Address - Street 1:415 W CARROLL AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4208
Practice Address - Country:US
Practice Address - Phone:626-963-1627
Practice Address - Fax:626-963-0467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA21194174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA21194Medicare UPIN