Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | G23461 | CA |
NPI | 1790792869 |
---|---|
Provider Name | Dr. Charles H Song |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-6814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 05/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A90825 | (02) | CA |