Individual
SAM HWA SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1408 3RD ST SE, 150 & 200, PUYALLUP, WA 98372-3702
(253) 697-3550
Mailing address
1408 3RD ST SE, 150 & 200, PUYALLUP, WA 98372-3702
(253) 697-3550
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD00038499
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0168702
L & I PROVIDER NUMBER
WA
01
—
6688SO
REGENCE RIDER NUMBER
WA
01
—
7024526
AETNA PROVIDER NUMBER
WA
05
—
8265118
—
WA
01
—
91120349445
KPS PROVIDER NUMBER
WA
01
—
98372D004
TRICARE PROVIDER NUMBER
WA
Enumeration date
05/27/2006
Last updated
05/02/2012
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