Individual
JI YOUNG SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
270 NEW STATE HWY STE 9A, RAYNHAM, MA 02767-5459
(226) 260-3587
Mailing address
350 N CLARK ST FL 6, CHICAGO, IL 60654-4712
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN1858108
MA
1223G0001X
General Practice Dentistry
Primary
DN1858201
MA
Other
Enumeration date
08/18/2018
Last updated
09/11/2024
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