Organization
MARK SONG MD PHD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK MYUNGJAE SONG M.D., PH.D. (PHYSICIAN SOLE OWNER)
(714) 626-0700
Entity
Organization
Contact information
Practice address
3663 WEST 6TH STREET, SUITE 307, LOS ANGELES, CA 90020
(213) 736-1884
(213) 736-1885
Mailing address
1401 S BROOKHURST RD, SUITE 100, FULLERTON, CA 92833-4471
(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
10/05/2006
Last updated
12/14/2011
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