Individual
MISTI MICHELLE SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1707 W CHARLESTON BLVD, 230, LAS VEGAS, NV 89102-2351
(702) 671-5060
(702) 384-6609
Mailing address
3016 W CHARLESTON BLVD STE 100, LAS VEGAS, NV 89102-1973
(702) 780-7118
(702) 671-6430
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
9942
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002018447
—
NV
05
—
100500484
—
NV
Enumeration date
01/04/2006
Last updated
06/01/2020
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