Provider Demographics
NPI:1396016838
Name:SON, CHANG O (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANG O
Middle Name:
Last Name:SON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:48 NEW MARKET SQUARE
Mailing Address - Street 2:JENCARE NEIGHBORHOOD MEDICAL NEW MARKET, LLC
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23605
Mailing Address - Country:US
Mailing Address - Phone:757-825-8030
Mailing Address - Fax:757-244-9003
Practice Address - Street 1:48 NEW MARKET SQUARE
Practice Address - Street 2:JENCARE NEIGHBORHOOD MEDICAL NEW MARKET, LLC
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23605
Practice Address - Country:US
Practice Address - Phone:757-825-8030
Practice Address - Fax:757-244-9003
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2014-08-18
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Provider Licenses
StateLicense IDTaxonomies
VA0101255714207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine