Individual
KAYLA SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
11201 BENTON ST # 112G, LOMA LINDA, CA 92357-3570
(909) 825-7084
Mailing address
11201 BENTON ST, LOMA LINDA, CA 92357-1000
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E5549
CA
Other
Enumeration date
06/22/2017
Last updated
10/21/2020
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