Provider Demographics
NPI:1518078039
Name:SONG, DAVID INKUN (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:INKUN
Last Name:SONG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4085 MALLORY LN
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8290
Mailing Address - Country:US
Mailing Address - Phone:615-778-0760
Mailing Address - Fax:615-778-0786
Practice Address - Street 1:4085 MALLORY LN
Practice Address - Street 2:SUITE 106
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-8290
Practice Address - Country:US
Practice Address - Phone:615-778-0760
Practice Address - Fax:615-778-0786
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM508213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4671140001OtherDME MAC
TN3812995Medicaid
TN4026804OtherBLUE CROSS BLUE SHIELD
TN4671140001OtherDME MAC
TN4026804OtherBLUE CROSS BLUE SHIELD
TNU57237Medicare UPIN