Coastal Vein and Cosmetic Center

Primary specialty

Phlebology PhysicianTaxonomy code 202K00000X

License

A86825 Issued in CA

Legal business name

COASTAL VEIN AND COSMETIC CENTER

Practice address

62 Corporate Park Ste 120
Irvine, CA 92606-3142

Phone

(949) 701-3394

Fax

(949) 748-8868

NPI assigned

Jan 3, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Ellen Teresa Song, M.D.

Title

President

Phone

(714) 904-5594

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1230940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1230940800000",
    "number": "1619113248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 CORPORATE PARK STE 120",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926063142",
            "telephone_number": "949-701-3394",
            "fax_number": "949-748-8868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62 CORPORATE PARK STE 120",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926063142",
            "telephone_number": "949-701-3394",
            "fax_number": "949-748-8868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL VEIN AND COSMETIC CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-03",
        "last_updated": "2009-01-03",
        "status": "A",
        "authorized_official_last_name": "SONG",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "TERESA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-904-5594",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "202K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Phlebology",
            "state": "CA",
            "license": "A86825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Phlebology Physician in Irvine, CA
• Providers in Irvine, CA by specialty
• Phlebology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2009; 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.