Provider Demographics
NPI:1821821257
Name:SONG, CLARA (DAC)
Entity type:Individual
Prefix:DR
First Name:CLARA
Middle Name:
Last Name:SONG
Suffix:
Gender:F
Credentials:DAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-3038 MAKALEA LOOP
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-5934
Mailing Address - Country:US
Mailing Address - Phone:808-343-9457
Mailing Address - Fax:
Practice Address - Street 1:226 N KUAKINI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2488
Practice Address - Country:US
Practice Address - Phone:808-343-9457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU-1315171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist