Provider Demographics
NPI:1740801646
Name:SONG DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:SONG DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MI HYE
Authorized Official - Middle Name:
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-786-5481
Mailing Address - Street 1:3500 MATAGORDA SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-6808
Mailing Address - Country:US
Mailing Address - Phone:972-786-5481
Mailing Address - Fax:
Practice Address - Street 1:1428 W HEBRON PKWY STE 120
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6347
Practice Address - Country:US
Practice Address - Phone:972-215-7855
Practice Address - Fax:469-284-5543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-01
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty