Individual provider Active NPI

Joanne Kim Song

  • Speech-Language Pathologist
  • Fountain Valley, CA
National Provider Identifier
1225360787
Registry record updated Oct 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
6633 Issued in CA
Practice address
18350 Mount Langley St Ste 105
Fountain Valley, CA 92708-6923
Phone
(714) 965-2324
Fax
(714) 965-2684
NPI assigned
Feb 9, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Assistant 2355S0801X SPA B64 CA
Speech-Language Pathologist 235Z00000X 6633 CA Primary

Addresses

Primary practice location

18350 Mount Langley St Ste 105
Fountain Valley, CA 92708-6923

Mailing address

18350 Mount Langley St Ste 105
Fountain Valley, CA 92708-6923
Phone (714) 965-2324

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
SPA B64CAMDSpeech-Language Assistant

NPI Registry JSON

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

{
    "created_epoch": "1265673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288224000000",
    "number": "1225360787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18350 MOUNT LANGLEY ST STE 105",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927086923",
            "telephone_number": "714-965-2324",
            "fax_number": "714-965-2684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18350 MOUNT LANGLEY ST STE 105",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927086923",
            "telephone_number": "714-965-2324",
            "fax_number": "714-965-2684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "JOANNE",
        "middle_name": "KIM",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-09",
        "last_updated": "2010-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2355S0801X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": "CA",
            "license": "SPA B64",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "6633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fountain Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2010; 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.