MEDICARE: JAE HYUN SONG M.D.

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	336015985	IL

General Provider Information

NPI Number	:	1609101054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAE HYUN SONG M.D.

Provider Business Mailing Address
First Line	:	8440 CALLIE AVE UNIT 311
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-5017
Country	:	US
Telephone Number	:	847-503-8775
Fax Number	:

Provider Business Practice Location Address
First Line	:	8440 CALLIE AVE UNIT 311
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-5017
Country	:	US
Telephone Number	:	847-503-8775
Fax Number	:

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

Provider Enumeration Date	:	10/02/2009
Last Update Date	:	05/17/2026

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