Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | D0084599 | MD |
N | 208000000X | Pediatrician | ME 100991 | FL |
NPI | 1003008467 |
---|---|
Provider Name | Dr. Esther Shinyoung Song |
First Address | Gaithersburg, MD 20879-3301 |
Second Address | Gaithersburg, MD 20879-3301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2007 |
Last Update Date | 24/06/2021 |