Provider Demographics
NPI:1295122265
Name:SONG, YOHAN (MD)
Entity type:Individual
Prefix:DR
First Name:YOHAN
Middle Name:
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 1:1360 UPPER HEMBREE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1230
Mailing Address - Country:US
Mailing Address - Phone:770-225-1874
Mailing Address - Fax:678-254-0618
Practice Address - Street 1:1360 UPPER HEMBREE RD STE 101
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1230
Practice Address - Country:US
Practice Address - Phone:770-225-1874
Practice Address - Fax:678-254-0618
Is Sole Proprietor?:No
Enumeration Date:2015-04-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA282986207Y00000X
GA90653207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology