Provider Demographics
NPI:1881763290
Name:SONG, SUN YONG (CA)
Entity type:Individual
Prefix:
First Name:SUN
Middle Name:YONG
Last Name:SONG
Suffix:
Gender:M
Credentials:CA
Other - Prefix:
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Mailing Address - Street 1:4698 CONVOY ST # C-104
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-2331
Mailing Address - Country:US
Mailing Address - Phone:858-467-1625
Mailing Address - Fax:858-467-1627
Practice Address - Street 1:4698 CONVOY ST # C-104
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2331
Practice Address - Country:US
Practice Address - Phone:858-467-1625
Practice Address - Fax:858-467-1627
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC3934171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist