Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 036101706 | IL |
N | 2086S0122X | Plastic and Reconstructive Surgery | MD044788 | DC |
NPI | 1043375884 |
---|---|
Provider Name | David H Song |
First Address | Washington, DC 20007-2113 |
Second Address | Washington, DC 20007-2113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 21/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036101706 | (05) | IL |