Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD61119552 | WA |
Y | 208600000X | Surgeon | MD61119552 | WA |
N | 2086S0122X | Plastic and Reconstructive Surgery | MD61119552 | WA |
NPI | 1255708731 |
---|---|
Provider Name | Ping Song |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98195-2781 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2015 |
Last Update Date | 05/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1255708731 | (05) | WA |