Provider Demographics
NPI:1013113026
Name:SONG, YOUNG SUK (MD)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:SUK
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 1:2801 ATLANTIC AVENUE
Mailing Address - Street 2:ATTN: RADIOLOGY DEPARTMENT
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806
Mailing Address - Country:US
Mailing Address - Phone:562-933-1550
Mailing Address - Fax:
Practice Address - Street 1:2801 ATLANTIC AVENUE
Practice Address - Street 2:ATTN: RADIOLOGY DEPARTMENT
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806
Practice Address - Country:US
Practice Address - Phone:562-933-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1157192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology