Provider Demographics
NPI:1861184681
Name:SONG, ZIHENG (PHD)
Entity type:Individual
Prefix:
First Name:ZIHENG
Middle Name:
Last Name:SONG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:JAOSN
Other - Middle Name:
Other - Last Name:SONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:99 ANTELOPE WAY UNIT 336
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4415
Mailing Address - Country:US
Mailing Address - Phone:888-868-8417
Mailing Address - Fax:
Practice Address - Street 1:4730 UNIVERSITY WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4424
Practice Address - Country:US
Practice Address - Phone:888-868-8417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP00762103TC0700X
WAAP61650187363LP0808X
CA95034932363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health