SONG PLASTIC SURGERY, INC. (NPI# 1730445313) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730445313 |
| Entity Type | Organization |
| Organization Name | SONG PLASTIC SURGERY, INC. |
| Practice Address |
4968 Booth Cir Suite 105 Irvine CA 92604-3360 |
| Practice Telephone | 9497014454 |
| Practice Fax Number | 9497014878 |
| Mailing Telephone | 9497014454 |
| Mailing Fax Number | 9497014878 |
| Enumeration Date | 2012-04-08 |
| Last Update Date | 2015-04-08 |
| Authorized Official Name | DR. KYLE ROBERT SONG (OWNER / PRINCIPAL) |
| Authorized Official Telephone | 9497014454 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0122X |
Surgery Specialization: Plastic and Reconstructive Surgery |
A102406 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MEDICARE PTAN | GA903A | 01 | |
| CA | MEDICARE PTAN | CK861T | 01 |
| Street Address |
4968 BOOTH CIR SUITE 105 |
| City | IRVINE |
| State | CA |
| Zip Code | 92604-3360 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821121328 | Felice L. Gersh, M.d., Inc. | Clinic/Center | 4968 Booth Cir, 101, Irvine, CA 92604-3360 | 2007-03-13 |
| 1477004919 | Ariana Poulakos | Naturopath | 4968 Booth Cir, Suite 101, Irvine, CA 92604-3360 | 2016-10-19 |
| 1982082020 | Orange County Plastic Surgery Center, LLC | Clinic/Center | 4968 Booth Cir, Suite 103, Irvine, CA 92604-3360 | 2015-05-08 |
| 1578829024 | Mindy Michele Finfrock | Pediatrics | 4968 Booth Cir, Irvine, CA 92604-3360 | 2012-04-10 |
| 1366620007 | Kyle Robert Song | Plastic Surgery | 4968 Booth Cir, Suite 105, Irvine, CA 92604-3360 | 2008-02-05 |
| 1922206135 | Jiyeon Kim | Pediatrics | 4968 Booth Cir, Suite 106, Irvine, CA 92604-3360 | 2007-07-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003417643 | New Skin and Body Aesthetics Inc | Internal Medicine | 4980 Barranca Parkway, 201, Irvine, CA 92604 | 2020-11-02 |
| 1679091144 | Alan Chang | Pharmacist | 5385 Alton Parkway, Irvine, CA 92604 | 2017-09-06 |
| 1942751599 | Haleh Ranjijifroody | Chiropractor | 4980 Barranca Parkway Unit 200, Irvine, CA 92604 | 2016-10-19 |
| 1265982136 | Nora M Balke | Nurse Practitioner | 4968 Booth Cir Ste 110, Irvine, CA 92604 | 2016-10-04 |
| 1679945612 | Cvs Pharmacy | Pharmacist | 15333 Culver Drive, Suite 300, Irvine, CA 92604 | 2015-10-29 |
| 1184016230 | Keri Blasingame | Nurse Practitioner | 4980 Barranca Parkway Suite 200, Irvine, CA 92604 | 2015-02-26 |
| 1679979827 | Oc Women's Health,apc | Obstetrics & Gynecology | 14252 Culver Drive Suite A 499, Irvine, CA 92604 | 2014-11-17 |
| 1326443920 | Peter Sumarsono Professional Dental Corporation | Preferred Provider Organization | 4605 Barranca Parkway., 200, Irvine, CA 92604 | 2014-10-27 |
| 1164832218 | Abdiel Noe Hernandez | Driver | 14252 Culver Drive Ste A, Irvine, CA 92604 | 2014-04-29 |
| 1811315781 | Trisha Sharma | Internal Medicine | 6 Willard St, Kaiser Permanente- Barranca Medical Office Building, Irvine, CA 92604 | 2014-03-28 |
| Find all providers in zip 92604 | ||||
| Taxonomy Code | 2086S0122X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Plastic and Reconstructive Surgery |
| A surgeon who specializes in plastic and reconstructive surgery. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356464739 | Graham Kemsley, M.d., Inc. | Surgery | 16300 Sand Canyon Ave Ste 911, Irvine, CA 92618-3709 | 2007-04-09 |
| 1538649116 | Chad Wu, Md, Inc | Surgery | 15825 Laguna Canyon Rd Ste 105, Irvine, CA 92618-2126 | 2018-08-14 |
| 1407186885 | Advanced Ear Nose and Throat Medical Group PC | Surgery | 3500 Barranca Pkwy, Suite 110, Irvine, CA 92606-8226 | 2010-01-06 |
| 1285748517 | Donald I Altman | Surgery | 16300 Sand Canyon Ave, Suite 1011, Irvine, CA 92618-3711 | 2006-08-17 |
| 1114933371 | Robert R. Beltran | Surgery | 3500 Barranca Pkwy, Ste. 110, Irvine, CA 92606-8226 | 2006-07-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699382523 | Beverly Hills Outpatient Surgery Center Inc | Surgery | 50 N La Cienega Blvd Ste 203, Beverly Hills, CA 90211-2246 | 2020-09-24 |
| 1558907857 | California Surgical and Anesthesia Services, Inc | Surgery | 3500 S Bristol St Ste 203, Santa Ana, CA 92704-7306 | 2019-11-21 |
| 1710533864 | Elite Transformations, A Professional Medical Corporation | Surgery | 1795 El Camino Real Ste 200, Palo Alto, CA 94306-1165 | 2019-08-14 |
| 1326503632 | Andre P. Marshall, Md Inc | Surgery | 32456 Crown Valley Pkwy Apt 105, Dana Point, CA 92629-3312 | 2019-01-31 |
| 1598245474 | Jenny Marie Hullinger | Surgery | 711 4th Ave Ste 200, San Diego, CA 92101-6863 | 2018-08-20 |
| 1497249817 | Alexander Villicana Md LLC | Surgery | 624 W Duarte Rd Ste 201, Arcadia, CA 91007-9261 | 2018-06-19 |
| 1316431273 | Justin E. West, Md Inc. | Surgery | 230 S Main St Ste 210, Orange, CA 92868-3851 | 2018-06-14 |
| 1811430234 | Marc Hamilton Hedrick | Surgery | 3020 Callan Rd, San Diego, CA 92121-1109 | 2016-12-02 |
| 1285082859 | Daniel Suissa | Surgery | 9201 W Sunset Blvd Ste 708, West Hollywood, CA 90069-3708 | 2016-05-24 |
| 1780030478 | Eric Yu Kit Li | Surgery | 10430 S De Anza Blvd Ste 170, Cupertino, CA 95014-3000 | 2016-05-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.