Seoyoun Song

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

108587 Issued in CA

Practice address

15769 Imperial Hwy
La Mirada, CA 90638-2510

Phone

(562) 217-4369

NPI assigned

Mar 9, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1615248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772236800000",
    "number": "1609451855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "647 DANIEL FREEMAN CIR",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903014146",
            "telephone_number": "347-391-7757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15769 IMPERIAL HWY",
            "city": "LA MIRADA",
            "state": "CA",
            "postal_code": "906382510",
            "telephone_number": "562-217-4369"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15435 S Western Ave Ste 101",
            "address_purpose": "LOCATION",
            "city": "Gardena",
            "state": "CA",
            "postal_code": "902494331",
            "country_code": "US",
            "telephone_number": "347-391-7757",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SONG",
        "first_name": "SEOYOUN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-09",
        "last_updated": "2026-02-28",
        "certification_date": "2026-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "39095",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "108587",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joon Woo Sohn, DMD
• Jonah Solomon, DNP
• Maria Celine Isabel Sombillo
• Andrew Phetaroun Somphonphakdy
• Seok Mo Son
• Adriana Belen Sosa Contreras
• Mariana Sosa
• Southern California Immediate Medical Center
• Southern California Specialty Care, Inc.
• Southern California Specialty Care, LLC

• General Practice Dentistry in La Mirada, CA
• Providers in La Mirada, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2026; 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.