Individual provider Active NPI

Hojun Song

  • General Practice Dentistry
  • Bangor, ME
National Provider Identifier
1700599735
Registry record updated Mar 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DEN5049 Issued in ME
Practice address
552 Stillwater Ave
Bangor, ME 04401-3522
Phone
(207) 973-1900
NPI assigned
Jan 4, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DEN5049 ME Primary
Student in an Organized Health Care Education/Training Program 390200000X
General Practice Dentistry 1223G0001X DEN.00206562 CO

Addresses

Primary practice location

552 Stillwater Ave
Bangor, ME 04401-3522

Mailing address

30 Wildwood Dr
Bangor, ME 04401-6522
Phone (929) 426-5340

Other practice location 1

1200 28th St Ste 300
Boulder, CO 80303-1756
Phone (303) 417-1644

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DEN.00206562COMDGeneral Practice Dentistry
DEN5049MEMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1672790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773532800000",
    "number": "1700599735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 WILDWOOD DR",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044016522",
            "telephone_number": "929-426-5340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "552 STILLWATER AVE",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013522",
            "telephone_number": "207-973-1900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 28th St Ste 300",
            "address_purpose": "LOCATION",
            "city": "Boulder",
            "state": "CO",
            "postal_code": "803031756",
            "country_code": "US",
            "telephone_number": "303-417-1644",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SONG",
        "first_name": "HOJUN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-01-04",
        "last_updated": "2026-03-15",
        "certification_date": "2026-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ME",
            "license": "DEN5049",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "DEN.00206562",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 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.