Provider Demographics
NPI:1447523667
Name:SONG, IN HEE (DMD, MD)
Entity type:Individual
Prefix:DR
First Name:IN HEE
Middle Name:
Last Name:SONG
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 FOWLER WAY STE 9
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5746
Mailing Address - Country:US
Mailing Address - Phone:530-328-0360
Mailing Address - Fax:
Practice Address - Street 1:1004 FOWLER WAY STE 9
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5746
Practice Address - Country:US
Practice Address - Phone:530-328-0360
Practice Address - Fax:530-328-0365
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-18
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0598011223S0112X
NY294967204E00000X
CAOMS1251223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery