Individual
DR. SEUNG JUN SONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, MS
Contact information
Practice address
622 W 168TH ST, NEW YORK, NY 10032-3720
(917) 575-3643
Mailing address
622 W 168TH ST, NEW YORK, NY 10032-3720
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
000106
NY
Other
Enumeration date
09/20/2019
Last updated
09/20/2019
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