Individual
MS. JIN SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14600 NW CORNELL RD, PORTLAND, OR 97229-5442
(503) 645-3581
(503) 629-8517
Mailing address
14600 NW CORNELL RD, PORTLAND, OR 97229, PORTLAND, OR 97229
(503) 645-3581
(503) 629-8517
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
201391285RN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679903801
—
OR
Enumeration date
11/25/2013
Last updated
07/21/2022
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