Provider Demographics
NPI:1992304844
Name:SONG, SEUNG YONG (DDS)
Entity type:Individual
Prefix:DR
First Name:SEUNG
Middle Name:YONG
Last Name:SONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 W DIMOND BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-1465
Mailing Address - Country:US
Mailing Address - Phone:907-333-6666
Mailing Address - Fax:
Practice Address - Street 1:1921 W DIMOND BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-1465
Practice Address - Country:US
Practice Address - Phone:907-333-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK165681122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist