Provider Demographics
NPI:1245341700
Name:SONG, JAMES J (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:SONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2299 MOWRY AVE
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1621
Mailing Address - Country:US
Mailing Address - Phone:510-713-9898
Mailing Address - Fax:510-280-7279
Practice Address - Street 1:2299 MOWRY AVE
Practice Address - Street 2:SUITE 3A
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:510-713-9898
Practice Address - Fax:510-280-7279
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2014-05-16
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Provider Licenses
StateLicense IDTaxonomies
CAAO68524207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A685240Medicaid
CA00A685240Medicare ID - Type Unspecified
CAG90775Medicare UPIN