Organization
SONG PLASTIC SURGERY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KYLE ROBERT SONG M.D. (OWNER / PRINCIPAL)
(949) 701-4454
Entity
Organization
Contact information
Practice address
4968 BOOTH CIR, SUITE 105, IRVINE, CA 92604-3360
(949) 701-4454
(949) 701-4878
Mailing address
4968 BOOTH CIR, SUITE 105, IRVINE, CA 92604-3360
(949) 701-4454
(949) 701-4878
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
A102406
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CK861T
MEDICARE PTAN
CA
01
—
GA903A
MEDICARE PTAN
—
Enumeration date
04/08/2012
Last updated
04/08/2015
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