Provider Demographics
NPI:1982629010
Name:SONG, JULIA (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:
Last Name:SONG
Suffix:
Gender:F
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:PO BOX 3187
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-3187
Mailing Address - Country:US
Mailing Address - Phone:847-922-2288
Mailing Address - Fax:
Practice Address - Street 1:2840 LONG BEACH BLVD
Practice Address - Street 2:SUITE 330
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1516
Practice Address - Country:US
Practice Address - Phone:562-427-0700
Practice Address - Fax:562-427-2525
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87753207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A877530Medicaid
CA00A877530Medicaid
00A877530Medicare ID - Type Unspecified