| Isse Song Pa | |
|
12554 S John Young Parkway 104 Orlando Florida FL 32837 | |
| (407) 888-1088 | |
| Not Available |
| Full Name | Isse Song Pa |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 12554 S John Young Parkway, Orlando Florida, Florida |
| Authorized Official Name and Position | Isse Song (DENTIST) |
| Authorized Official Contact | 4078881088 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Isse Song Pa 12554 S John Young Parkway 104 Orlando Florida FL 32837 Ph: (407) 888-1088 | Isse Song Pa 12554 S John Young Parkway 104 Orlando Florida FL 32837 Ph: (407) 888-1088 |
| NPI Number | 1366871394 |
|---|---|
| Provider Enumeration Date | 11/12/2013 |
| Last Update Date | 11/12/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366871394 | NPI | - | NPPES |
| 075248700 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |