DR. SOO KYUNG SONG (NPI# 1750740072) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750740072 |
| Entity Type | Individual |
| Full Name | DR. SOO KYUNG SONG |
| Other Name | DR. SOO KYUNG LEE |
| Credential | DDS, MS |
| Practice Address |
2610 W Olympic Blvd Ste 200 Los Angeles CA 90006-3859 |
| Practice Telephone | 2133835437 |
| Mailing Telephone | 2133835437 |
| Enumeration Date | 2016-02-15 |
| Last Update Date | 2019-07-31 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
101142 | CA | Dental Providers |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | CA | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 100 E Valencia Mesa Dr Ste 102, Fullerton, CA 928353816 | 7149925437 | |
| 1610 W Edinger Ave Ste C, Santa Ana, CA 927044339 | 7144327337 | |
| 665 E Foothill Blvd Ste L, Claremont, CA 917113581 | 9093995022 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215190947 | Soo Ok Song | Dentist | 344 Main St, Barnstable, MA 02601 | 2008-07-02 |
| 1538269337 | Soo Ja Song | Chore Provider | 2776 Pacific Ave, Long Beach, CA 90806-2613 | 2006-09-22 |
| Street Address |
2610 W OLYMPIC BLVD STE 200 |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90006-3859 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962829143 | California Oral & Facial Surgery, Inc. | Dentist | 2610 W Olympic Blvd Ste 200, Los Angeles, CA 90006-2807 | 2014-03-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114583549 | Ruahrena Corporation | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 3053 West Olympic Boulevard, Suite 301, Los Angeles, CA 90006 | 2019-05-10 |
| 1770048266 | Luxi Optometry, Inc | Ophthalmology | 3250 W. Olympic Blvd #221, Los Angeles, CA 90006 | 2019-02-08 |
| 1053895565 | Lili Mirtorabi D.d.s A Professional Corporation | Dentist | 2368 Pico Boulevard, Los Angeles, CA 90006 | 2018-09-20 |
| 1083192116 | Sanghee Hong | Nurse Practitioner | 2655 W Olympic Blvd Ste 101, Los Angeles, CA 90006 | 2018-07-31 |
| 1134638919 | Joon Hyung Kim | Chiropractor | 3130 W. Olympic Blvd., Suite 350, Los Angeles, CA 90006 | 2017-09-25 |
| 1578082988 | Judy Lee | Behavior Technician | 900 South Serrano Ave #401, Los Angeles, CA 90006 | 2017-09-18 |
| 1689126773 | Seungah Madison Lee | Acupuncturist | 3053 W. Olympic Blvd, #311, Los Angeles, CA 90006 | 2016-10-25 |
| 1790149789 | Kihyun Kim | Acupuncturist | 975 S. Vermont Ave, #201, Los Angeles, CA 90006 | 2016-04-06 |
| 1407215486 | Young Zoo Kim | Acupuncturist | 1001 S. Vermont Ave, #207, L.a., CA 90006 | 2016-02-18 |
| 1376916817 | Global Eastern Medicine Group | Acupuncturist | 1010 S. Fedora St. #101, Los Angeles, CA 90006 | 2015-11-05 |
| Find all providers in zip 90006 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790385227 | Johnson Ann Wong Dental Corporation | Dentist | 6512 N Figueroa St Ste 3, Los Angeles, CA 90042-2155 | 2020-10-26 |
| 1326535949 | Haejin Kang | Dentist | 3932 Wilshire Blvd Ste 200, Los Angeles, CA 90010-3307 | 2018-04-19 |
| 1609382860 | Dr Daniel Meir Klein Dds, Apc | Dentist | 5001 Wilshire Blvd Ste 209, Los Angeles, CA 90036-6104 | 2017-12-22 |
| 1154858082 | Jenny Garcia | Dentist | 1042 1/2 N Ardmore Ave, Los Angeles, CA 90029-2402 | 2017-05-23 |
| 1013365881 | Jessica Yoon Kyung Pack | Dentist | 1234 Wilshire Blvd Apt 212, Los Angeles, CA 90017-1974 | 2016-06-02 |
| 1588011225 | Chelsea Elese Zamudio | Dentist | 1125 S Wooster St, Los Angeles, CA 90035-1405 | 2016-05-23 |
| 1457707861 | Denisse Monroy | Dentist | 11900 Goshen Ave Apt 103, Los Angeles, CA 90049-6379 | 2016-05-04 |
| 1851784268 | Woo Ram Lee | Dentist | 1343 S Carmelina Ave, Apt 7, Los Angeles, CA 90025-1987 | 2015-03-09 |
| 1982010427 | Tiffany Wu | Dentist | 5262 E Beverly Blvd, Los Angeles, CA 90022-2002 | 2014-07-04 |
| 1447664578 | Jack Yeung | Dentist | 1222 Mcclellan Dr Apt 2, Los Angeles, CA 90025-1010 | 2014-06-17 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90006 |
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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.