Provider Demographics
NPI:1851474829
Name:SONG, JOSEPH K (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:K
Last Name:SONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16262 E WHITTIER BLVD
Mailing Address - Street 2:SUITE 21
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603
Mailing Address - Country:US
Mailing Address - Phone:562-902-7700
Mailing Address - Fax:562-902-7704
Practice Address - Street 1:16262 E WHITTIER BLVD
Practice Address - Street 2:SUITE 21
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603
Practice Address - Country:US
Practice Address - Phone:562-902-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69832207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G698320Medicaid
CA00G698320Medicaid
G69832Medicare ID - Type Unspecified