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General NPI Number Information
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NPI Number | 1629066642
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Entity Type | Organization
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Legal Business Name | 18THMEDCOM
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 121GENERAL HOSPITAL BOX709
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City | APO
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State | AP
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Zip | 96205
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Country | US
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Telephone | 01182279166027
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Fax |
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Provider Business Mailing Address
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Address Line | 121GENERAL HOSPITAL BOX709
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City | APO
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State | AP
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Zip | 96205
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Country | US
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Telephone | 01182279166027
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. SOONHI SONG.
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Credential | M.D.
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Telephone | 11-822-7917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2865M2000X
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Taxonomy Name | Military General Acute Care Hospital
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License Number | 016541
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License Number State | CT
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