MEDICARE: YONG JAE SONG MD INC

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	207R00000X	Internal Medicine Physician		OH

Other Identifiers

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

General Provider Information

NPI Number	:	1053478297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YONG JAE SONG MD INC

Provider Business Mailing Address
First Line	:	6731 RIDGE RD
Second Line	:	SUITE 302
City	:	PARMA
State	:	OH
Zip	:	44129-5708
Country	:	US
Telephone Number	:	440-843-7772
Fax Number	:	440-845-0430

Provider Business Practice Location Address
First Line	:	6731 RIDGE RD
Second Line	:	SUITE 302
City	:	PARMA
State	:	OH
Zip	:	44129-5708
Country	:	US
Telephone Number	:	440-843-7772
Fax Number	:	440-845-0430

Authorized Official
Title or Position	:	OWNER
Name	:	YONG J. SONG
Credential	:	M.D.
Telephone Number	:	440-843-7772

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	05/13/2010

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Directions to “YONG JAE SONG MD INC ” Practice Location

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