Provider Demographics
NPI:1144660671
Name:SONG, WENDY (DO)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:SONG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2474 E HUNT HWY
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-5210
Mailing Address - Country:US
Mailing Address - Phone:480-543-6680
Mailing Address - Fax:480-543-5908
Practice Address - Street 1:2474 E HUNT HWY
Practice Address - Street 2:SUITE 10
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-5210
Practice Address - Country:US
Practice Address - Phone:480-543-6680
Practice Address - Fax:480-543-5908
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2017-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ006834207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine