MEDICARE: DR. YONG J SONG

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	35040147	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	:	1548253792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YONG J SONG

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	05/14/2010

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