Provider Demographics
NPI:1316286560
Name:HONG, SONG SIK (DC)
Entity type:Individual
Prefix:DR
First Name:SONG
Middle Name:SIK
Last Name:HONG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7220 WOODMAN AVE.
Mailing Address - Street 2:SUITE 207
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2668
Mailing Address - Country:US
Mailing Address - Phone:818-787-1845
Mailing Address - Fax:818-787-2032
Practice Address - Street 1:7220 WOODMAN AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2668
Practice Address - Country:US
Practice Address - Phone:818-787-1845
Practice Address - Fax:818-787-2032
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18274111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor