Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 25MA09284600 | NJ |
Y | 207VX0201X | Gynecologic Oncologist | C170610 | CA |
NPI | 1144665423 |
---|---|
Provider Name | Mihae Song |
First Address | Los Angeles, CA 90051-0185 |
Second Address | Duarte, CA 91010-3012 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2013 |
Last Update Date | 28/10/2020 |