Provider Demographics
NPI:1851474829
Name:SONG, JOSEPH K (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:K
Last Name:SONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7571 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-2315
Mailing Address - Country:US
Mailing Address - Phone:714-539-2600
Mailing Address - Fax:714-539-2611
Practice Address - Street 1:7571 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621
Practice Address - Country:US
Practice Address - Phone:714-539-2600
Practice Address - Fax:714-539-2611
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69832207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G698320Medicaid
CA00G698320Medicaid
G69832Medicare ID - Type Unspecified