Organization
SONG DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN T SONG DDS (PRESIDENT)
(262) 719-6842
Entity
Organization
Contact information
Practice address
2920 HUNTINGTON DR STE 238, SAN MARINO, CA 91108-2254
(626) 286-9211
Mailing address
936 S OLIVE ST APT 734, LOS ANGELES, CA 90015-3679
(262) 719-6842
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
09/16/2018
Last updated
09/16/2018
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