| NPI | 1104933183 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK MYUNGJAE SONG Physician/Sole Owner 701-626-0700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: CA A49785) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2011-01-14 |