Provider Demographics
NPI:1053735340
Name:SONG, ZHENG (MD)
Entity type:Individual
Prefix:
First Name:ZHENG
Middle Name:
Last Name:SONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 NILES ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-4922
Mailing Address - Country:US
Mailing Address - Phone:661-328-4284
Mailing Address - Fax:661-616-9977
Practice Address - Street 1:7800 NILES ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-4922
Practice Address - Country:US
Practice Address - Phone:661-328-4284
Practice Address - Fax:661-616-9977
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTL11478390200000X
PAMA056701363AM0700X
CAPA53625363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program