Provider Demographics
NPI:1639421688
Name:SONG, HYUNJA
Entity Type:Individual
Prefix:
First Name:HYUNJA
Middle Name:
Last Name:SONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 90TH ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7881
Mailing Address - Country:US
Mailing Address - Phone:347-421-8103
Mailing Address - Fax:
Practice Address - Street 1:3720 90TH ST
Practice Address - Street 2:APT. 2
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7881
Practice Address - Country:US
Practice Address - Phone:347-421-8103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY559118163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse