Provider Demographics
NPI:1952868804
Name:SONG, YOON SANG (DC)
Entity Type:Individual
Prefix:DR
First Name:YOON SANG
Middle Name:
Last Name:SONG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 MARLTON PIKE E STE F33
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2150
Mailing Address - Country:US
Mailing Address - Phone:856-234-1200
Mailing Address - Fax:856-234-1206
Practice Address - Street 1:1930 MARLTON PIKE E STE F33
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2150
Practice Address - Country:US
Practice Address - Phone:856-234-1200
Practice Address - Fax:856-234-1206
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2024-04-04
Deactivation Date:2019-02-28
Deactivation Code:
Reactivation Date:2019-03-12
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00800600111N00000X
PADC011458111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor