NPIMap

Individual provider Active NPI

Isse Song

  • General Practice Dentistry
  • Orlando, FL
National Provider Identifier
1003238650
Registry record updated Jan 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN11703 Issued in FL
Practice address
12554 S John Young Pkwy
Suite104
Orlando, FL 32837-4004
Phone
(407) 888-1088
Fax
(407) 888-1089
NPI assigned
Jan 16, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 16, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN11703 FL Primary

Addresses

Primary practice location

12554 S John Young Pkwy
Suite104
Orlando, FL 32837-4004

Mailing address

12554 S John Young Pkwy
Suite104
Orlando, FL 32837-4004
Phone (407) 888-1088

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DN11703FLMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Isse Song Dental Office General Practice Past Accepting new patients
Isse Song PA General Practice Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1389830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389830400000",
    "number": "1003238650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12554 S JOHN YOUNG PKWY",
            "address_2": "SUITE104",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328374004",
            "telephone_number": "407-888-1088",
            "fax_number": "407-888-1089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12554 S JOHN YOUNG PKWY",
            "address_2": "SUITE104",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328374004",
            "telephone_number": "407-888-1088",
            "fax_number": "407-888-1089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "ISSE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-01-16",
        "last_updated": "2014-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN11703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.