Provider Demographics
NPI:1922675313
Name:SONG, LEI (LAC, MSAOM)
Entity Type:Individual
Prefix:
First Name:LEI
Middle Name:
Last Name:SONG
Suffix:
Gender:M
Credentials:LAC, MSAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:596 W HUNTINGTON DR UNIT D
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-3463
Mailing Address - Country:US
Mailing Address - Phone:323-842-7886
Mailing Address - Fax:
Practice Address - Street 1:3007 HUNTINGTON DR STE 200
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-5522
Practice Address - Country:US
Practice Address - Phone:323-842-7886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-05
Last Update Date:2021-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18878171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist