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1962720425

NPI Code Detail

MEDICARE: DR. KIMBERLY SONG MD

MEDICARE: DR. KIMBERLY 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
1	208600000X	Surgery Physician	295045-1	NY
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	295045-1	NY

General Provider Information

NPI Number	:	1962720425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY SONG MD

Provider Business Mailing Address
First Line	:	408 E 92ND ST APT 23A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-6838
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8318 4TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4413
Country	:	US
Telephone Number	:	718-748-0500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2010
Last Update Date	:	08/13/2019

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Directions to “ DR. KIMBERLY SONG MD” Practice Location

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