Provider Demographics
NPI:1922569557
Name:SONG, CATHARINE JEEYOUNG (DDS)
Entity type:Individual
Prefix:DR
First Name:CATHARINE
Middle Name:JEEYOUNG
Last Name:SONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S BEVERLY DR STE 401
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4807
Mailing Address - Country:US
Mailing Address - Phone:310-551-2955
Mailing Address - Fax:310-551-2955
Practice Address - Street 1:300 S BEVERLY DR STE 401
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4807
Practice Address - Country:US
Practice Address - Phone:310-551-2955
Practice Address - Fax:310-551-2955
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104028122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist