| Doctor Name: | MIJU SONG |
| NPI Number: | 1083072680 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 863440 |
| Business Practice Address: | 800 W Central Texas Expy Ste 125 Harker Heights, TX - 765481899 |
| Business Phone Number: | 2546181151 |
| Business Fax Number: | 2546181077 |
| Mailing Address: | 4206 Retama Cir, VICTORIA |
| State: | TX |
| Postal Code: | 779012765 |
| Phone Number: | 3615720333 |
| Fax Number: | 3615720104 |
| NPI Enumeration Date: | 02/10/2016 |
| NPI Last Update Date: | 02/17/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 863440 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |