Provider Demographics
NPI:1881933562
Name:JASON SONG ACUPUNCTURE & HERBS, INC.
Entity type:Organization
Organization Name:JASON SONG ACUPUNCTURE & HERBS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:L.AC
Authorized Official - Prefix:
Authorized Official - First Name:JUN
Authorized Official - Middle Name:
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:OMD
Authorized Official - Phone:818-757-1269
Mailing Address - Street 1:19231 VICTORY BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-6308
Mailing Address - Country:US
Mailing Address - Phone:818-757-1269
Mailing Address - Fax:818-757-0281
Practice Address - Street 1:19231 VICTORY BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6308
Practice Address - Country:US
Practice Address - Phone:818-757-1269
Practice Address - Fax:818-757-0281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 5702171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty