MEDICARE: WENDY SONG DO

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	207Q00000X	Family Medicine Physician	006834	AZ

General Provider Information

NPI Number	:	1144660671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY SONG DO

Provider Business Mailing Address
First Line	:	2474 E HUNT HWY
Second Line	:	SUITE 10
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85143-5210
Country	:	US
Telephone Number	:	480-543-6680
Fax Number	:	480-543-5908

Provider Business Practice Location Address
First Line	:	2474 E HUNT HWY
Second Line	:	SUITE 10
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85143-5210
Country	:	US
Telephone Number	:	480-543-6680
Fax Number	:	480-543-5908

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

Provider Enumeration Date	:	06/28/2013
Last Update Date	:	04/23/2017

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