Provider Demographics
NPI:1235932708
Name:DR. JONATHAN SONG LLC
Entity type:Organization
Organization Name:DR. JONATHAN SONG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-360-2039
Mailing Address - Street 1:106 W OSBORN RD # 1133
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3909
Mailing Address - Country:US
Mailing Address - Phone:480-360-2039
Mailing Address - Fax:909-265-9445
Practice Address - Street 1:9630 E SHEA BLVD # AZ
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6267
Practice Address - Country:US
Practice Address - Phone:480-360-2039
Practice Address - Fax:909-265-9445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty