Provider Demographics
NPI:1396078804
Name:OK, SONG I (DDS)
Entity type:Individual
Prefix:DR
First Name:SONG
Middle Name:I
Last Name:OK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:OK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:325 CHINA BASIN ST
Mailing Address - Street 2:UNIT 512
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158-2142
Mailing Address - Country:US
Mailing Address - Phone:206-227-0904
Mailing Address - Fax:
Practice Address - Street 1:325 CHINA BASIN ST
Practice Address - Street 2:UNIT 512
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-2142
Practice Address - Country:US
Practice Address - Phone:206-227-0904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60107492122300000X
CA65153122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist