Immi Song, D.D.S., M.S.
Individual provider Active NPI Orthodontics and Dentofacial Orthopedics Dentistry · Albany, CA
NPI 1467571554 · NPPES record last updated Jun 14, 2022
Key facts
- NPI
- 1467571554
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X
- License
- 40732 (CA)
- Practice address
- 1301 Solano Ave Ste 101
Albany, CA 94706-1825 - Phone
- (510) 528-2220
- Fax
- (510) 528-2280
- NPI assigned
- Mar 28, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40732 | CA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Christopher W. Leyster, DDS, a Professional Corporation | Orthodontics and Dentofacial Orthopedics | Current |
Accepting new patients |
Locations
1301 Solano Ave
Ste 101
Albany, CA 94706
Phone (510) 528-2220
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 40732 | CA | Yes |
Addresses
Primary practice location
1301 Solano Ave Ste 101
Albany, CA 94706-1825
Mailing address
1301 Solano Ave Ste 101
Albany, CA 94706-1825
Phone (510) 528-2220
Other providers in Albany, CA
- Robyn Elizabeth Smith
- Adam Snider
- So & Valdez, a Professional Dental Corporatiom
- Rebecca Liora Soffer
- Solano Eyecare Optometric Professionals
- Sonya Brewer Psychotherapy Group, PC
- Source for Wellness
- Dmitrius Spartos
- Nan Evans Spencer
- Maryellen M Sternad
All providers in Albany, CA · Orthodontics and Dentofacial Orthopedics Dentistry in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 14, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.