Provider Demographics
NPI:1356978373
Name:SONG, YANG (DO)
Entity type:Individual
Prefix:DR
First Name:YANG
Middle Name:
Last Name:SONG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:SONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:549 E BRAMBLETON AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2905
Mailing Address - Country:US
Mailing Address - Phone:757-393-1136
Mailing Address - Fax:757-533-9441
Practice Address - Street 1:549 E BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2905
Practice Address - Country:US
Practice Address - Phone:757-393-1136
Practice Address - Fax:757-533-9441
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102208331207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine