Individual
MRS. CHARLENE Y SONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
520 S VIRGIL AVE, #203, LOS ANGELES, CA 90020-1416
(213) 386-1004
(213) 386-1115
Mailing address
520 S VIRGIL AVE, #203, LOS ANGELES, CA 90020-1416
(213) 386-1004
(213) 386-1115
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G65248
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G65248
—
CA
01
—
G65248
CALIF LICENSE
CA
Enumeration date
10/04/2006
Last updated
12/02/2008
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