Provider Demographics
NPI:1780303396
Name:PAK, SONG (DVM)
Entity type:Individual
Prefix:
First Name:SONG
Middle Name:
Last Name:PAK
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 94 BOX 521
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09824-0006
Mailing Address - Country:US
Mailing Address - Phone:517-918-0047
Mailing Address - Fax:
Practice Address - Street 1:BLDG 912
Practice Address - Street 2:B CAD AVE
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09824
Practice Address - Country:US
Practice Address - Phone:314-676-5953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6901400727251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare