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

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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