MEDICARE: DR. CHENG CHIEN 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	207V00000X	Obstetrics & Gynecology Physician	H2010	TX
2	207V00000X	Obstetrics & Gynecology Physician	R0003	TX

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	:	1669431094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHENG CHIEN SONG M.D.

Provider Business Mailing Address
First Line	:	1001 12TH AVE STE 154
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3929
Country	:	US
Telephone Number	:	817-810-9997
Fax Number	:	817-810-9978

Provider Business Practice Location Address
First Line	:	1001 12TH AVE STE 154
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3929
Country	:	US
Telephone Number	:	817-810-9997
Fax Number	:	817-810-9978

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	03/13/2017

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Directions to “ DR. CHENG CHIEN SONG M.D.” Practice Location

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