Provider Demographics
NPI:1740628775
Name:SONG, JAMES KANG (LAC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:KANG
Last Name:SONG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:KANG SOK
Other - Middle Name:
Other - Last Name:SONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:2846 W 8TH ST
Mailing Address - Street 2:#208
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-1589
Mailing Address - Country:US
Mailing Address - Phone:213-272-3004
Mailing Address - Fax:
Practice Address - Street 1:2846 W 8TH ST
Practice Address - Street 2:#208
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-1589
Practice Address - Country:US
Practice Address - Phone:213-272-3004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8498171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist