Yong Jin Song, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D8398 Issued in OR

Practice address

10009 NE Hazel Dell Ave
Vancouver, WA 98685

Phone

(360) 574-3070

NPI assigned

Mar 7, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642723200000",
    "number": "1659401750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "527 SE BASELINE ST STE C",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971234149",
            "telephone_number": "503-648-6054",
            "fax_number": "503-648-6099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10009 NE HAZEL DELL AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "98685",
            "telephone_number": "360-574-3070"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "527 SE Baseline St Ste C",
            "address_purpose": "LOCATION",
            "city": "Hillsboro",
            "state": "OR",
            "postal_code": "971234149",
            "country_code": "US",
            "telephone_number": "503-648-6054",
            "fax_number": "503-648-6099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SONG",
        "first_name": "YONG JIN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-07",
        "last_updated": "2022-01-21",
        "certification_date": "2022-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "9772",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D8398",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5050794",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "songfamilydental.net",
            "affiliation": "N",
            "endpointDescription": "Dental",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "527 SE Baseline St Ste C",
            "city": "Hillsboro",
            "state": "OR",
            "country_code": "US",
            "postal_code": "971234149",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nat Somboun
• Regina Ann Somerville, SUDP
• Matthew P. Sommers, MPT
• Gemma-Noelani Somol
• William Song, DMD
• Songbird Psychological Services, PLLC
• Amanda Marie Sonnenburg, DO
• Shanna Sonnier, PCD(DONA)
• Sonus-USA, Inc.
• Ellen Soper, MS, LMHC

• General Practice Dentistry in Vancouver, WA
• Providers in Vancouver, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.