| Doctor Name: | DR. JASON JEONG HWAN SONG |
| NPI Number: | 1205074002 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D., PH.D |
| License Number: | 236756 |
| Business Practice Address: | 1671 N Clyde Morris Blvd Suite 100 Daytona Beach, FL - 321175590 |
| Business Phone Number: | 3862742977 |
| Business Fax Number: | 3862742997 |
| Mailing Address: | 1671 N Clyde Morris Blvd, Suite 100 DAYTONA BEACH |
| State: | FL |
| Postal Code: | 321175590 |
| Phone Number: | 3862742977 |
| Fax Number: | 3862742997 |
| NPI Enumeration Date: | 02/02/2009 |
| NPI Last Update Date: | 06/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | 236756 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MA |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |