Provider Demographics
NPI:1518798354
Name:SONG, JOSEPH SUNG EUN
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:SUNG EUN
Last Name:SONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 WEYBURN PLACE
Mailing Address - Street 2:ALOE, 404
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024
Mailing Address - Country:US
Mailing Address - Phone:847-542-8232
Mailing Address - Fax:
Practice Address - Street 1:920 WEYBURN PLACE
Practice Address - Street 2:ALOE, 404
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024
Practice Address - Country:US
Practice Address - Phone:847-542-8232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program