Provider Demographics
NPI:1033633532
Name:CHAE, SONGAH
Entity Type:Individual
Prefix:
First Name:SONGAH
Middle Name:
Last Name:CHAE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 NORTHWOOD DRIVE. #60
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:875 PERIMETER DRIVE
Practice Address - Street 2:MS 3080
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83844-3080
Practice Address - Country:US
Practice Address - Phone:208-885-1673
Practice Address - Fax:208-885-5929
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program