Song Plastic Surgery, Inc.

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

A102406 Issued in CA

Legal business name

SONG PLASTIC SURGERY, INC.

Practice address

4968 Booth Cir
Suite 105
Irvine, CA 92604-3360

Phone

(949) 701-4454

Fax

(949) 701-4878

NPI assigned

Apr 8, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Kyle Robert Song, M.D.NPI 1366620007

Title

Owner / Principal

Phone

(949) 701-4454

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kyle Robert Song, MD

  • Plastic Surgery Physician
  • Irvine, CA
  • NPI 1366620007
  Medicare reassignment Authorized official
• Paige Madison Benyamein, MD

  • Plastic Surgery Physician
  • Irvine, CA
  • NPI 1689162919
  Medicare reassignment NPD
• Ali Anwaar Qureshi, M.D.

  • Plastic Surgery Physician
  • Irvine, CA
  • NPI 1922354281
  Medicare reassignment NPD

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

{
    "created_epoch": "1333843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428451200000",
    "number": "1730445313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4968 BOOTH CIR",
            "address_2": "SUITE 105",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926043360",
            "telephone_number": "949-701-4454",
            "fax_number": "949-701-4878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4968 BOOTH CIR",
            "address_2": "SUITE 105",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926043360",
            "telephone_number": "949-701-4454",
            "fax_number": "949-701-4878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SONG PLASTIC SURGERY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-08",
        "last_updated": "2015-04-08",
        "status": "A",
        "authorized_official_last_name": "SONG",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER / PRINCIPAL",
        "authorized_official_telephone_number": "949-701-4454",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "CA",
            "license": "A102406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "GA903A",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "CK861T",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Suzanna Miri Son
• Tiffany Jeehae Son, MD
• Maher Sonbol
• Maya Sonbol
• Daniel Sonboli
• Ci Song
• Ellen Teresa Song, M.D.
• Hongwoo Song, DO
• Kyle Robert Song, MD
• Seon Song

• Plastic and Reconstructive Surgery Physician in Irvine, CA
• Providers in Irvine, CA by specialty
• Plastic and Reconstructive Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.