Individual
MARK MYUNGJAE SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
3663 W 6TH ST STE 307, LOS ANGELES, CA 90020-3050
(213) 736-1884
(714) 626-0800
Mailing address
1401 S BROOKHURST RD STE 100, FULLERTON, CA 92833-4492
(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
07/20/2006
Last updated
12/01/2011
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