Provider Demographics
NPI:1790325306
Name:SONG, WON (RN)
Entity Type:Individual
Prefix:
First Name:WON
Middle Name:
Last Name:SONG
Suffix:
Gender:M
Credentials:RN
Other - Prefix:DR
Other - First Name:WON
Other - Middle Name:
Other - Last Name:SONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, MSN, DBA, RN-BC
Mailing Address - Street 1:5430 W RAIL CANYON RD
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-9430
Mailing Address - Country:US
Mailing Address - Phone:240-899-0319
Mailing Address - Fax:
Practice Address - Street 1:907 W BOONE AVE STE B
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2503
Practice Address - Country:US
Practice Address - Phone:240-899-0319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-11
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health