Ji Soo Song

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

1211 N Broadway
Santa Ana, CA 92701-3411

Phone

(888) 367-1850

NPI assigned

Nov 20, 2024

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

California Dermatology Institute PCGroup PAC ID 6800177460, 25 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• California Dermatology Institute PC

  • Dermatology Physician
  • Thousand Oaks, CA
  • NPI 1235671389
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1732060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732147200000",
    "number": "1619792900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 N BROADWAY",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927013411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 N BROADWAY",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927013411",
            "telephone_number": "888-367-1850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "JI SOO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-11-20",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thongsai Sophia Somkhit, LVN
• Eunji Son
• Janice Son, AMFT
• Sophie Song-Fang, AMFT
• Alicia Song
• Joann K Song
• Linfei Song, BEHAVIORAL ANALYST
• Olivia Grace Song
• Aileen Karen Pamintuan Songco
• David Sonnenberg

• Physician Assistant in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.