Active NPI
Kyle Robert Song, MD
- Plastic Surgery Physician
- Irvine, CA
National Provider Identifier
1366620007
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- License
- A102406
- Practice address
- 4968 Booth Cir
Suite 105
Irvine, CA 92604-3360 - Phone
- (949) 701-4454
- Fax
- (949) 701-4878
- NPI assigned
- Feb 5, 2008
- Last updated
- Apr 8, 2015
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | A102406 | CA | Primary |
Addresses
Primary practice location
4968 Booth Cir
Suite 105
Irvine, CA 92604-3360
Mailing address
4968 Booth Cir
Suite 105
Irvine, CA 92604-3360
Phone (949) 701-4454
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saddleback Memorial Medical Center | Past | Accepting new patients | |
| Dignity Health | Past | Accepting new patients | |
| Hoag Memorial Hospital Presbyterian | Past | Accepting new patients | |
| Sutter Valley Hospitals | Past | Accepting new patients |
Organizations & group practices 6
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Plastic and Reconstructive Surgery Physician
- Irvine, CA
- NPI 1730445313
-
- Ambulatory Surgical Clinic/Center
- Irvine, CA
- NPI 1982082020
-
- General Acute Care Hospital
- Newport Beach, CA
- NPI 1518951300
-
- Rehabilitation Hospital Unit
- Laguna Hills, CA
- NPI 1114967114
-
- General Acute Care Hospital
- Sacramento, CA
- NPI 1811946734
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202169600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428451200000",
"number": "1366620007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4968 BOOTH CIR",
"address_2": "SUITE 105",
"city": "IRVINE",
"state": "CA",
"postal_code": "926043360",
"telephone_number": "949-701-4454",
"fax_number": "949-701-4878"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4968 BOOTH CIR",
"address_2": "SUITE 105",
"city": "IRVINE",
"state": "CA",
"postal_code": "926043360",
"telephone_number": "949-701-4454",
"fax_number": "949-701-4878"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SONG",
"first_name": "KYLE",
"middle_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-02-05",
"last_updated": "2015-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "CA",
"license": "A102406",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irvine, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2015; 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.