Provider Demographics
NPI:1255080339
Name:SONG, CANDICE EUNYOUNG (DO)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:EUNYOUNG
Last Name:SONG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 CHILDRENS LN
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1910
Mailing Address - Country:US
Mailing Address - Phone:757-668-7249
Mailing Address - Fax:
Practice Address - Street 1:1950 GLENN MITCHELL DR STE 310
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0019
Practice Address - Country:US
Practice Address - Phone:757-507-0255
Practice Address - Fax:757-507-0256
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102209370208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics