# COASTAL VEIN AND COSMETIC CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619113248
- **Authorized official:** DR. ELLEN TERESA SONG M.D. (PRESIDENT)
- **Authorized official phone:** (714) 904-5594

## Contact information

- **Practice address:** 62 CORPORATE PARK STE 120, IRVINE, CA 92606-3142
- **Practice address phone:** (949) 701-3394
- **Practice address fax:** (949) 748-8868
- **Mailing address:** 62 CORPORATE PARK STE 120, IRVINE, CA 92606-3142
- **Mailing address phone:** (949) 701-3394
- **Mailing address fax:** (949) 748-8868

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 202K00000X | Phlebology Physician | A86825 | CA | Yes |

## Other

- **Enumeration date:** 01/03/2009
- **Last updated:** 01/03/2009