Provider Demographics
NPI:1861470460
Name:SONG, YONG DUCK (MD)
Entity type:Individual
Prefix:DR
First Name:YONG
Middle Name:DUCK
Last Name:SONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1611 27TH ST
Mailing Address - Street 2:STE 204 BLDG J
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662
Mailing Address - Country:US
Mailing Address - Phone:740-353-3196
Mailing Address - Fax:740-353-1258
Practice Address - Street 1:1611 27TH ST
Practice Address - Street 2:STE 204 BLDG J
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662
Practice Address - Country:US
Practice Address - Phone:740-353-3196
Practice Address - Fax:740-353-1258
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36581207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0223949Medicaid
A74623Medicare UPIN
OH0395681Medicare ID - Type Unspecified