Provider Demographics
NPI:1144092479
Name:IN HEE SONG DMD, MD, INC
Entity type:Organization
Organization Name:IN HEE SONG DMD, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:IN HEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-328-0360
Mailing Address - Street 1:1004 FOWLER WAY STE 9
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5746
Mailing Address - Country:US
Mailing Address - Phone:530-328-0360
Mailing Address - Fax:
Practice Address - Street 1:1004 FOWLER WAY STE 9
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5746
Practice Address - Country:US
Practice Address - Phone:530-328-0360
Practice Address - Fax:530-328-0365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty