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

Jiyoun Song

Individual provider Registered Nurse · NPI 1003347253

Jiyoun Song is a Nurse Practitioner in Flushing, New York. Qualified in 2017, 9 years ago. Practices with Beacon Health Medical PC, a 35-clinician group. Licensed in New York.

Years since qualifying
9
Licensed in
NY
In the registry since
2017
Specialties on file
2
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Practice location Address checks out

15408 Northern Blvd #2K
Flushing, NY 11354-5040
Phone: (718) 445-0200
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Acute Care Nurse Practitioner (primary) Taxonomy 363LA2100X · Licence 431104 (NY)
Registered Nurse Taxonomy 163W00000X · Licence 694059 (NY)

Record details

NPI number1003347253
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedMarch 21, 2017
Last updated in NPPESMarch 21, 2017
Mailing address15408 Northern Blvd, 2k, Flushing, NY 11354-5040

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Beacon Health Medical Pc — 35 clinicians
Accepts Medicare assignment Not indicated

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