Provider Demographics
NPI:1194125591
Name:SONG, JANE (DDS)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:SONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 LEXINGTON AVE
Mailing Address - Street 2:SUITE 6900
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10174
Mailing Address - Country:US
Mailing Address - Phone:206-335-8594
Mailing Address - Fax:
Practice Address - Street 1:405 LEXINGTON AVE
Practice Address - Street 2:SUITE 6900
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10174-0002
Practice Address - Country:US
Practice Address - Phone:206-335-8594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0575961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice