NPIMap

Organization Active NPI

Dae H. Song D.D.S. Inc.

  • General Practice Dentistry
  • Huntington Park, CA
National Provider Identifier
1417133158
Registry record updated Mar 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
25630 Issued in CA
Legal business name
DAE H. SONG D.D.S. INC.
Practice address
6011 Pacific Blvd
Suite # 120
Huntington Park, CA 90255-2951
Phone
(323) 584-6777
NPI assigned
Jan 11, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2016

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

Authorized official

Name
Dr. Dae H. Song, DDS
Title
Owner
Phone
(323) 584-6777

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 25630 CA Primary

Addresses

Primary practice location

6011 Pacific Blvd
Suite # 120
Huntington Park, CA 90255-2951

Mailing address

6011 Pacific Blvd
Suite # 120
Huntington Park, CA 90255-2951
Phone (323) 584-6777

Other names 1

  • BELGRAVE FAMILY DENTAL GROUP Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Belgrave Family Dental Group3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1200009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458518400000",
    "number": "1417133158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6011 PACIFIC BLVD",
            "address_2": "SUITE # 120",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "902552951",
            "telephone_number": "323-584-6777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6011 PACIFIC BLVD",
            "address_2": "SUITE # 120",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "902552951",
            "telephone_number": "323-584-6777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAE H. SONG D.D.S. INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-11",
        "last_updated": "2016-03-21",
        "status": "A",
        "authorized_official_last_name": "SONG",
        "authorized_official_first_name": "DAE",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "323-584-6777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "25630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BELGRAVE FAMILY DENTAL GROUP",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Huntington Park, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2016; 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.