Active NPI
Jin Song
- Pharmacist
- Upland, CA
National Provider Identifier
1497110225
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH 67613
- Practice address
- 311 S Mountain Ave
Upland, CA 91786-7032 - Phone
- (909) 981-0717
- NPI assigned
- Dec 21, 2015
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH 67613 | CA | Primary |
Addresses
Primary practice location
311 S Mountain Ave
Upland, CA 91786-7032
Mailing address
311 S Mountain Ave
Upland, CA 91786-7032
Phone (909) 981-0717
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 |
|---|---|---|---|
| RPH 67613 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1450656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450656000000",
"number": "1497110225",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "311 S MOUNTAIN AVE",
"city": "UPLAND",
"state": "CA",
"postal_code": "917867032",
"telephone_number": "909-981-0717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "311 S MOUNTAIN AVE",
"city": "UPLAND",
"state": "CA",
"postal_code": "917867032",
"telephone_number": "909-981-0717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SONG",
"first_name": "JIN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-12-21",
"last_updated": "2015-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "RPH 67613",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Upland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.