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NPI Code Detail

MEDICARE: CHUNG SONG MD

MEDICARE: CHUNG SONG MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician036068375IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710914999
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHUNG SONG MD
Provider Business Mailing Address
First Line : 2910 CHEROKEE LN
Second Line :
City : RIVERWOODS
State : IL
Zip : 60015-1609
Country : US
Telephone Number : 773-651-2188
Fax Number : 773-651-9655
Provider Business Practice Location Address
First Line : 6202 S HALSTED ST
Second Line :
City : CHICAGO
State : IL
Zip : 60621-2029
Country : US
Telephone Number : 773-651-2188
Fax Number : 773-651-9655
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2006
Last Update Date : 01/29/2008

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Directions to “ CHUNG SONG MD” Practice Location

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