Provider Demographics
NPI:1982794079
Name:SONG-YOON, SOO YEE (MD)
Entity Type:Individual
Prefix:
First Name:SOO
Middle Name:YEE
Last Name:SONG-YOON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SOO
Other - Middle Name:YEE
Other - Last Name:SONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3323 W OLYMPIC BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-2353
Mailing Address - Country:US
Mailing Address - Phone:323-733-0121
Mailing Address - Fax:323-733-0295
Practice Address - Street 1:3323 W OLYMPIC BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-2353
Practice Address - Country:US
Practice Address - Phone:323-733-0121
Practice Address - Fax:323-733-0295
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29576207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA295760Medicaid
CAC35360Medicare UPIN