Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ji Soo Song

Individual provider Physician Assistant · NPI 1619792900

Ji Soo Song is a Physician Assistant in Santa Ana, California. Qualified in 2024, 2 years ago. Practices with California Dermatology Institute PC, a 23-clinician group and accepts Medicare assignment.

Years since qualifying
2
In the registry since
2024
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Practice location Address checks out

1211 N Broadway
Santa Ana, CA 92701-3411
Phone: (888) 367-1850
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1619792900
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedNovember 20, 2024
Last updated in NPPESNovember 21, 2024
Certification dateNovember 21, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice California Dermatology Institute Pc — 23 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Santa Ana