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General NPI Number Information
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NPI Number | 1568275931
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Entity Type | Individual
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Provider Name | OK KYU SONG MD
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Gender | Male
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Dates
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Enumeration Date | 01/29/2025
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 55 FRUIT ST
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City | BOSTON
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State | MA
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Zip | 02114-2696
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Country | US
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Telephone | 617-726-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 BEACON ST APT 1112
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City | BROOKLINE
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State | MA
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Zip | 02446-2253
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Country | US
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Telephone | 650-313-3630
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 3017713
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License Number State | MA
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