Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 125068714 | IL |
Y | 207N00000X | Dermatologist | A168835 | CA |
NPI | 1013367200 |
---|---|
Provider Name | Betty Sihui Song |
First Address | Claremont, CA 91711-3304 |
Second Address | Claremont, CA 91711-3304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2016 |
Last Update Date | 02/02/2022 |