Simon Ki Song, D.O.M.

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

7495 Issued in CA

Practice address

2601 N. del Rosa Ave.
Suite 111
San Bernardino, CA 92404

Phone

(909) 474-9108

Fax

(310) 376-8788

NPI assigned

Nov 4, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Mr. Ki Soo Song Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

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

{
    "created_epoch": "1162598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577059200000",
    "number": "1770662181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 N. DEL ROSA AVE.",
            "address_2": "SUITE 111",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "92404",
            "telephone_number": "909-474-9108",
            "fax_number": "310-976-8788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 N. DEL ROSA AVE.",
            "address_2": "SUITE 111",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "92404",
            "telephone_number": "909-474-9108",
            "fax_number": "310-376-8788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "SIMON",
        "middle_name": "KI",
        "name_prefix": "Mr.",
        "credential": "D.O.M.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-04",
        "last_updated": "2019-12-23",
        "certification_date": "2019-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "CA",
            "license": "AC 7495",
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "CA",
            "license": "7495",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KI SOO",
            "last_name": "SONG",
            "prefix": "MR.",
            "credential": "D.O.M.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Solutions Counseling Center Inc
• Somra Nursing Corporation (Somra Psychiatric Care)
• In Gi Son, D.D.S.
• Esther Song
• Kristy Nicole Song
• Sood Kisra, MD., PC.
• Gabriela Soria
• Daisy Sosa
• Irene Del Carmen Sosa, CHW
• Olga Aracely Sosa, PSY. D, LEP

• Acupuncturist in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Acupuncturist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.