Provider Demographics
NPI:1821274218
Name:SONG, YUNSANG (LAC)
Entity Type:Individual
Prefix:MR
First Name:YUNSANG
Middle Name:
Last Name:SONG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6242 BEACH BLVD
Mailing Address - Street 2:UNIT B
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-2399
Mailing Address - Country:US
Mailing Address - Phone:714-523-2780
Mailing Address - Fax:714-523-2781
Practice Address - Street 1:6242 BEACH BLVD
Practice Address - Street 2:UNIT B
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-2399
Practice Address - Country:US
Practice Address - Phone:714-523-2780
Practice Address - Fax:714-523-2781
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11527171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist