Jin Song, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

DE61516940 Issued in WA

Practice address

2611 S Quillan PL Ste 110
Kennewick, WA 99338-1899

Phone

(509) 585-5437

NPI assigned

Jun 4, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Jin Ha Sung Other name

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1370304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713139200000",
    "number": "1023456753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2611 S QUILLAN PL STE 110",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993381899",
            "telephone_number": "509-585-5437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2611 S QUILLAN PL STE 110",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993381899",
            "telephone_number": "509-585-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "JIN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-04",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "29005",
            "primary": false
        },
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "WA",
            "license": "DE61516940",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE61516940",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JIN",
            "last_name": "SUNG",
            "middle_name": "HA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Christina Solomon
• John Michael Solomon
• Esther Solonka
• Drew J Sonderland, PMHNP
• Clementine Elliot Sondheim
• Julie Song, OD
• Shikha Sood Gandhi, DDS
• Carissa Sorbel, LMT
• Kraig C Sorensen, DPT
• Thomas Carl Sorensen, MD

• Dentist in Kennewick, WA
• Providers in Kennewick, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.