Provider Demographics
NPI:1831870195
Name:ABOUT U MD WELLNESS
Entity type:Organization
Organization Name:ABOUT U MD WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-904-5594
Mailing Address - Street 1:20 SEA FAIR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92657-1912
Mailing Address - Country:US
Mailing Address - Phone:714-904-5594
Mailing Address - Fax:949-200-4506
Practice Address - Street 1:5020 CAMPUS DR STE 200
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2111
Practice Address - Country:US
Practice Address - Phone:949-757-1150
Practice Address - Fax:949-757-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty