Elisa Hae-Jung Song, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A68766 Issued in CA

Practice address

1601 El Camino Real
Suite 101
Belmont, CA 94002-3948

Phone

(650) 595-5437

Fax

(650) 595-5438

NPI assigned

Mar 1, 2007

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 15, 2016 through Mar 15, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Whole Child Wellness, Inc

  • Nutritionist
  • Belmont, CA
  • NPI 1720299308

  Pediatrics

  NPD (past) Authorized official
• California Em-I Medical Services

  • Emergency Medicine Physician
  • San Francisco, CA
  • NPI 1649229600
  NPD (past)
• LPCH Medical Group Div of Lucile

  • Children's Hospital
  • Palo Alto, CA
  • NPI 1417907940

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669500484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1085 HEWITT DR",
            "city": "SAN CARLOS",
            "state": "CA",
            "postal_code": "940703650",
            "telephone_number": "650-654-9345",
            "fax_number": "650-654-9345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 EL CAMINO REAL",
            "address_2": "SUITE 101",
            "city": "BELMONT",
            "state": "CA",
            "postal_code": "940023948",
            "telephone_number": "650-595-5437",
            "fax_number": "650-595-5438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "ELISA",
        "middle_name": "HAE-JUNG",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A68766",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Jacobo Smith
• James Michael Smyrak, D.D.S.
• Terri Snyder, SPEECH THERAPIST
• Alexa Sockol
• Elizabeth Soda, MD
• Jin Oh Song, L.AC.
• Sarika Sood, DDS
• Oscar Jovani Soriano
• Gabriel Thomas South
• Spring Speech Therapy, PC

• Pediatrics Physician in Belmont, CA
• Providers in Belmont, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.