Most Relevant Information
Provider Data
| NPI Number: | 1003347253 |
| Provider Name: | JIYOUN SONG |
| Entity Type: | Individual |
| Taxonomy Code: | 163W00000X |
| Specialty: | Registered Nurse |
| License Number: | 694059 |
Most Important Dates
| Enumeration Date: | 03/21/2017 |
| Last Updated: | 03/21/2017 |
Provider Practice Location
15408 NORTHERN BLVD
#2K
FLUSHING
NY
113545040
Practice Location Phone/Fax
| Phone: | 7184450200 |
| Fax: |
Provider Mailing Location
15408 NORTHERN BLVD
#2K
FLUSHING
NY
113545040
Provider Mailing Phone/Fax
| Phone: | 7184450200 |
| Fax: |