| Michael Song Md A Professional Medical Corporation | |
|
501 W Broadway Ste 800 San Diego CA 92101-3546 | |
| (858) 349-3501 | |
| (858) 365-5180 |
| Full Name | Michael Song Md A Professional Medical Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 501 W Broadway Ste 800, San Diego, California |
| Authorized Official Name and Position | Michael Song (CEO) |
| Authorized Official Contact | 8583493501 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael Song Md A Professional Medical Corporation 501 W Broadway Ste 800 San Diego CA 92101-3546 Ph: (858) 349-3501 | Michael Song Md A Professional Medical Corporation 501 W Broadway Ste 800 San Diego CA 92101-3546 Ph: (858) 349-3501 |
| NPI Number | 1710751730 |
|---|---|
| Provider Enumeration Date | 11/09/2023 |
| Last Update Date | 11/09/2023 |
| Medicare PECOS PAC ID | 5991155186 |
|---|---|
| Medicare Enrollment ID | O20240101000068 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710751730 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Michael Yu Song |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1437537859 PECOS PAC ID: 8022382274 Enrollment ID: I20170926004269 |
| Provider Name | Yomiyyu Gammada |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1144571167 PECOS PAC ID: 1456669068 Enrollment ID: I20220622003158 |
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