Provider Demographics
NPI:1730517780
Name:SONG, YANLING (A/G NP)
Entity type:Individual
Prefix:
First Name:YANLING
Middle Name:
Last Name:SONG
Suffix:
Gender:F
Credentials:A/G NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 VIA LARGO
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-3450
Mailing Address - Country:US
Mailing Address - Phone:714-797-3292
Mailing Address - Fax:
Practice Address - Street 1:23961 CALLE DE LA MAGDALENA
Practice Address - Street 2:STE 333
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-452-1930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000042363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology