Provider Demographics
NPI:1871753525
Name:SONG, SHLEE SANG-HYUN (MD)
Entity type:Individual
Prefix:DR
First Name:SHLEE
Middle Name:SANG-HYUN
Last Name:SONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SANG-HYUN
Other - Middle Name:SHAY
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8700 BEVERLY BLVD
Mailing Address - Street 2:DEPT OF NEUROLOGY, THALIANS, SUITE E216
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1804
Mailing Address - Country:US
Mailing Address - Phone:310-423-5349
Mailing Address - Fax:310-248-8038
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:DEPT OF NEUROLOGY, THALIANS, SUITE E216
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-423-5349
Practice Address - Fax:310-248-8038
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00676552084V0102X
DCMD0374322084V0102X
CAA1167472084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA116747OtherTHE MEDICAL BOARD OF CALIFORNIA
MDD0067655OtherMARYLAND BOARD OF PHYSICIANS
DCMD037432OtherDC HEALTH PROFESSIONAL LICENSING ADMINISTRATION, BOARD OF MEDICINE