Provider Demographics
NPI:1245041110
Name:SONG, JONATHAN J
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:J
Last Name:SONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 ALBANY ST APT 907A
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02119-2580
Mailing Address - Country:US
Mailing Address - Phone:650-454-7834
Mailing Address - Fax:
Practice Address - Street 1:815 ALBANY ST APT 907A
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02119-2580
Practice Address - Country:US
Practice Address - Phone:650-454-7834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-18
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program