Active NPI
Diane Jungyun Song, OD
- Optometrist
- Valencia, CA
National Provider Identifier
1891788725
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT11750T
- Practice address
- 26926 The Old Rd
Valencia, CA 91381-0662 - Phone
- (661) 310-3445
- Fax
- (661) 310-1999
- NPI assigned
- Aug 25, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT11750T | CA | Primary |
Addresses
Primary practice location
26926 The Old Rd
Valencia, CA 91381-0662
Mailing address
26926 The Old Rd
Valencia, CA 91381-0662
Phone (661) 310-3445
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SD0117500 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPT11750T | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186358400000",
"number": "1891788725",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26926 THE OLD RD",
"city": "VALENCIA",
"state": "CA",
"postal_code": "913810662",
"telephone_number": "661-310-3445",
"fax_number": "661-310-1999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26926 THE OLD RD",
"city": "VALENCIA",
"state": "CA",
"postal_code": "913810662",
"telephone_number": "661-310-3445",
"fax_number": "661-310-1999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SONG",
"first_name": "DIANE",
"middle_name": "JUNGYUN",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-08-25",
"last_updated": "2007-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "OPT11750T",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SD0117500",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Valencia, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.