Provider Demographics
NPI:1467526947
Name:SONG, CHIN KYONG (MD)
Entity Type:Individual
Prefix:DR
First Name:CHIN
Middle Name:KYONG
Last Name:SONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6355 NE CORNELL ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124
Mailing Address - Country:US
Mailing Address - Phone:503-597-3130
Mailing Address - Fax:503-597-3130
Practice Address - Street 1:6355 NE CORNELL ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124
Practice Address - Country:US
Practice Address - Phone:503-597-3130
Practice Address - Fax:503-597-3140
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD24412207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227028Medicaid
OR116158Medicare ID - Type Unspecified
ORH78254Medicare UPIN