Individual
DR. TAIIL TED SONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
11203 BRIDGEPORT WAY SW, LAKEWOOD, WA 98499-3002
(253) 589-1380
Mailing address
11203 BRIDGEPORT WAY SW, LAKEWOOD, WA 98499-3002
(253) 589-1380
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
OP00002163
WA
207KA0200X
Allergy Physician
OP00002163
WA
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
E-2006
AR
Other
Enumeration date
12/11/2006
Last updated
09/14/2021
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