Provider Demographics
NPI:1740458645
Name:LUO, SONG (LACMD, PHD, MPH)
Entity type:Individual
Prefix:
First Name:SONG
Middle Name:
Last Name:LUO
Suffix:
Gender:M
Credentials:LACMD, PHD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27020 CEDAR RD APT 1617
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1163
Mailing Address - Country:US
Mailing Address - Phone:512-771-9187
Mailing Address - Fax:
Practice Address - Street 1:1950 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-3719
Practice Address - Country:US
Practice Address - Phone:216-448-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00950171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist