Provider Demographics
NPI:1457997645
Name:DAVID G SONG MD INC
Entity Type:Organization
Organization Name:DAVID G SONG MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-234-9178
Mailing Address - Street 1:2100 MONTEZUMA AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-3803
Mailing Address - Country:US
Mailing Address - Phone:626-234-9178
Mailing Address - Fax:
Practice Address - Street 1:5365 WALNUT AVENUE STE A
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-9171
Practice Address - Country:US
Practice Address - Phone:909-902-0009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID G SONG MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-21
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty