Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD00024272 | WA |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | MD00024272 | WA |
NPI | 1366523623 |
---|---|
Provider Name | Kit M Song |
First Address | Philadelphia, PA 19178-7642 |
Second Address | Los Angeles, CA 90020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 06/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7115 | INTERNAL ID-MOTOR VEHICLE ID (01) | |
8186215 | (05) | WA |
G24512 | (02) |