Nina Song, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

34312TLG Issued in CA

Practice address

1640 Camino del Rio N Ste 200
San Diego, CA 92108-1523

Phone

(619) 299-4888

NPI assigned

Sep 12, 2019

Sex

Female

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1568246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576022400000",
    "number": "1790335610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 CAMINO DEL RIO N STE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921081523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 CAMINO DEL RIO N STE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921081523",
            "telephone_number": "619-299-4888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7038 Katella Ave",
            "address_purpose": "LOCATION",
            "city": "Stanton",
            "state": "CA",
            "postal_code": "906802805",
            "country_code": "US",
            "telephone_number": "619-272-1216",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SONG",
        "first_name": "NINA",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-12",
        "last_updated": "2019-12-11",
        "certification_date": "2019-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "34312TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eun Young Song, PHARM D
• Hannah Song
• Ilseong Song, PT, DPT
• Jae Hoon Song, M.ED, BCBA
• Jiwoo Song
• Richard Sung Jun Song, M.D
• Seo Beom Song
• Seung-Yil Song, M.D.
• Steve Song, MD
• Sun Yong Song, C.A.

• Optometrist in San Diego, CA
• Providers in San Diego, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2019; 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.