MEDICARE: MI-KYOUNG 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	207WX0107X	Retina Specialist (Ophthalmology) Physician	MD207140	OR

General Provider Information

NPI Number	:	1619962131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MI-KYOUNG SONG M.D.

Provider Business Mailing Address
First Line	:	5125 SKYLINE RD S
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97306-9413
Country	:	US
Telephone Number	:	503-361-5400
Fax Number	:

Provider Business Practice Location Address
First Line	:	5125 SKYLINE RD S
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97306-9427
Country	:	US
Telephone Number	:	503-361-5400
Fax Number	:

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	01/16/2024

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Directions to “ MI-KYOUNG SONG M.D.” Practice Location

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