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NPI Code Detail

MEDICARE: TAEJUNG SONG DO

MEDICARE: TAEJUNG 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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1629912423
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAEJUNG SONG DO
Provider Business Mailing Address
First Line : 839 W CONGRESS ST
Second Line :
City : TUCSON
State : AZ
Zip : 85745-2819
Country : US
Telephone Number : 520-670-3909
Fax Number : 520-309-2560
Provider Business Practice Location Address
First Line : 839 W CONGRESS ST
Second Line :
City : TUCSON
State : AZ
Zip : 85745-2819
Country : US
Telephone Number : 520-670-3909
Fax Number : 520-309-2560
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2026
Last Update Date : 06/13/2026

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Directions to “ TAEJUNG SONG DO” Practice Location

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