Grace Song, PNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

95030060 Issued in CA

Practice address

327 N Boylston St Apt 419
Los Angeles, CA 90012-4683

Phone

(732) 939-1646

NPI assigned

Jul 4, 2024

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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: grace.song.1@11920.direct.athenahealth.com

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.

• Tpirc Medical Foundation Inc

  • Pediatric Allergy/Immunology Physician
  • Long Beach, CA
  • NPI 1225611312

  Pediatrics

  Medicare reassignment NPD

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

{
    "created_epoch": "1720051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720051200000",
    "number": "1790521185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "327 N BOYLSTON ST APT 419",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900124683",
            "telephone_number": "732-939-1646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "327 N BOYLSTON ST APT 419",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900124683",
            "telephone_number": "732-939-1646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "GRACE",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-04",
        "last_updated": "2024-07-04",
        "certification_date": "2024-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CA",
            "license": "95030060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Song, CPNP
• Dwight J Song, PHARM.D.
• Eric Yue Song, MD
• Eugene Song, DDS
• Eun Song, L.AC. PH.D.
• Ha Jung Song, F.N.P
• Hae-Ri Song, MD
• Hank Jin Song, MD
• James I Song, PHARM. D.
• James Kang Song, L.AC.

• Pediatric Nurse Practitioner in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Pediatric Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.