Provider Demographics
NPI:1659646354
Name:SAE RYOUNG SONG, M.D., P.A.
Entity Type:Organization
Organization Name:SAE RYOUNG SONG, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-846-9496
Mailing Address - Street 1:6245 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-6006
Mailing Address - Country:US
Mailing Address - Phone:727-846-9496
Mailing Address - Fax:727-849-8410
Practice Address - Street 1:6245 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-6006
Practice Address - Country:US
Practice Address - Phone:727-846-9496
Practice Address - Fax:727-849-8410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00299682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045480000Medicaid
FLD60902Medicare UPIN
FL02770Medicare PIN