Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 53357 | CA |
NPI | 1023137387 |
---|---|
Provider Name | Dr. Yun U Song |
First Address | Irvine, CA 92603-1604 |
Second Address | Irvine, CA 92604-4731 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 08/07/2007 |