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General NPI Number Information
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NPI Number | 1205074002
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Entity Type | Individual
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Provider Name | JASON JEONG HWAN SONG M.D., PH.D
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Gender | Male
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Dates
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Enumeration Date | 02/02/2009
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Last Update Date | 10/27/2023
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Provider Practice Location Address
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Address Line | 2801 17TH ST UNIT 202
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City | SAINT CLOUD
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State | FL
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Zip | 34769-4939
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Country | US
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Telephone | 407-906-1328
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Fax | 866-425-8143
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Provider Business Mailing Address
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Address Line | 2801 17TH ST UNIT 202
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City | SAINT CLOUD
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State | FL
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Zip | 34769-4939
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Country | US
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Telephone | 407-906-1328
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Fax | 866-425-8143
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | ME123792
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | ME123792
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 236756
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 123792
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License Number State | FL
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