Organization
SPECIALTY MEDICAL CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK MYUNGJAE SONG MD (PHYSICIAN/SOLE OWNER)
(701) 626-0700
Entity
Organization
Contact information
Practice address
1401 S BROOKHURST RD, SUIT 100, FULLERTON, CA 92833
(714) 626-0700
(714) 626-0800
Mailing address
1401 S BROOKHURST RD, SUIT 100, FULLERTON, CA 92833
(714) 626-0700
(714) 626-0800
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
A49785
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A497850
—
CA
Enumeration date
08/24/2006
Last updated
01/14/2011
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