| NPI | 1336682764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON JEONG HWAN SONG Medical Director 267-312-9857 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation |
| 208VP0014X Pain Medicine, Interventional Pain Medicine | |
| Enumeration Date | 2016-12-03 |
| Last Update Date | 2020-10-01 |