Provider Demographics
NPI:1942661285
Name:VO, SONG (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SONG
Middle Name:
Last Name:VO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14773 PALMERA CT
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3446
Mailing Address - Country:US
Mailing Address - Phone:714-548-5986
Mailing Address - Fax:
Practice Address - Street 1:8700 BEVERLY BLVD # 2900A
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:800-233-2771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15-02320103K00000X
CA298510225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst