Provider Demographics
NPI:1750740072
Name:SONG, SOO KYUNG (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:SOO
Middle Name:KYUNG
Last Name:SONG
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:SOO
Other - Middle Name:KYUNG
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:686 E UNION STREET
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-5828
Mailing Address - Country:US
Mailing Address - Phone:626-460-1002
Mailing Address - Fax:626-460-0406
Practice Address - Street 1:686 E UNION STREET
Practice Address - Street 2:SUITE 150
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-5828
Practice Address - Country:US
Practice Address - Phone:626-460-1002
Practice Address - Fax:626-460-0406
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1011421223P0221X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry