Provider Demographics
NPI:1427872399
Name:SONG, PIYOU (LAC)
Entity type:Individual
Prefix:DR
First Name:PIYOU
Middle Name:
Last Name:SONG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 SPACE PARK WAY SPC 106
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-1403
Mailing Address - Country:US
Mailing Address - Phone:951-384-0016
Mailing Address - Fax:
Practice Address - Street 1:1075 SPACE PARK WAY SPC 106
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-1403
Practice Address - Country:US
Practice Address - Phone:951-384-0016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20219171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist