Sue Song, OTR

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Practice address

4640 Admiralty Way Ste 420
Marina del Rey, CA 90292-6617

Phone

(424) 526-5151

Fax

(424) 835-6475

NPI assigned

Nov 9, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Sue Yang Former name

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": "1636416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697760000000",
    "number": "1891451480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4640 ADMIRALTY WAY STE 420",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4640 ADMIRALTY WAY STE 420",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926617",
            "telephone_number": "424-526-5151",
            "fax_number": "424-835-6475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "SUE",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-09",
        "last_updated": "2023-10-20",
        "certification_date": "2023-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CA",
            "license": "25057",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUE",
            "last_name": "YANG",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Terese Higbie Smith, MSPT
• Katherine Price Snedaker, LCSW
• Irving Sobel, MD
• Gloria Oluwakemi Sobowale, PHARMD
• Jill L. Somerville, P.T.
• Alexander Sorokurs, M.D.
• Walter Sorto
• Layla Nina Sotoodeh, PA-C
• Southern California Neuro Medical Services Inc
• Piyush Srivastava, MD

• Occupational Therapist in Marina del Rey, CA
• Providers in Marina del Rey, CA by specialty
• Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2023; 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.