Provider Demographics
NPI:1902101090
Name:SONG, ANGELA JIHYE (NP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:JIHYE
Last Name:SONG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W LA VETA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4301
Mailing Address - Country:US
Mailing Address - Phone:714-835-1800
Mailing Address - Fax:714-975-7433
Practice Address - Street 1:1010 W LA VETA AVE STE 200
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4301
Practice Address - Country:US
Practice Address - Phone:714-835-1800
Practice Address - Fax:714-975-7433
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19038363L00000X
CA707308163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse