Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A166400 | CA |
NPI | 1003311689 |
---|---|
Provider Name | Laurie Song |
First Address | San Francisco, CA 94158-2545 |
Second Address | San Francisco, CA 94158-2545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2018 |
Last Update Date | 16/08/2021 |