Individual
GRACE SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
327 N BOYLSTON ST APT 419, LOS ANGELES, CA 90012-4683
(732) 939-1646
Mailing address
327 N BOYLSTON ST APT 419, LOS ANGELES, CA 90012-4683
(732) 939-1646
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
95030060
CA
Other
Enumeration date
07/04/2024
Last updated
07/04/2024
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