Individual
JAEMIN SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
145 CANAL ST FL 2, NEW YORK, NY 10002-5033
(917) 388-3678
Mailing address
2935 JOHN F KENNEDY BLVD APT 610, JERSEY CITY, NJ 07306-3881
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
062257
NY
1223G0001X
General Practice Dentistry
DN1858981
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/30/2020
Last updated
09/06/2023
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