Active NPI
Ki Jung Song, L.A.C.
- Acupuncturist
- Desert Hot Springs, CA
National Provider Identifier
1326311317
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- AC11210
- Practice address
- 11625 Palm Dr
Suite G
Desert Hot Springs, CA 92240-3629 - Phone
- (760) 251-3032
- NPI assigned
- Feb 22, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | AC11210 | CA | Primary |
Addresses
Primary practice location
11625 Palm Dr
Suite G
Desert Hot Springs, CA 92240-3629
Mailing address
25619 Santa Barbara St
Moreno Valley, CA 92557-5847
Phone (951) 247-9829
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
| License | State | Type | Specialty |
|---|---|---|---|
| AC11210 | CA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1329868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329868800000",
"number": "1326311317",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25619 SANTA BARBARA ST",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925575847",
"telephone_number": "951-247-9829"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11625 PALM DR",
"address_2": "SUITE G",
"city": "DESERT HOT SPRINGS",
"state": "CA",
"postal_code": "922403629",
"telephone_number": "760-251-3032"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SONG",
"first_name": "KI",
"middle_name": "JUNG",
"name_prefix": "Dr.",
"credential": "L.A.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-02-22",
"last_updated": "2012-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "CA",
"license": "AC11210",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Desert Hot Springs, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.