Individual
JONATHAN CHENG SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1450 SAN PABLO ST, LOS ANGELES, CA 90033-5331
(323) 442-6335
Mailing address
PO BOX 31309, LOS ANGELES, CA 90031-0309
(323) 442-6335
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
G79733
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G797330
—
CA
Enumeration date
09/27/2006
Last updated
12/01/2021
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