Individual
JIYOUN SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15408 NORTHERN BLVD, #2K, FLUSHING, NY 11354-5040
(718) 445-0200
Mailing address
15408 NORTHERN BLVD, #2K, FLUSHING, NY 11354-5040
(718) 445-0200
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
694059
NY
363LA2100X
Acute Care Nurse Practitioner
Primary
431104
NY
Other
Enumeration date
03/21/2017
Last updated
03/21/2017
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