Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DE00009411 | WA |
NPI | 1063483733 |
---|---|
Provider Name | Dr. Zhengshi Song |
First Address | Chesapeake, VA 23323-3820 |
Second Address | Chesapeake, VA 23323-3820 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 08/07/2007 |