Provider Demographics
NPI:1538291216
Name:SONG, IN CHUL (MD)
Entity Type:Individual
Prefix:DR
First Name:IN CHUL
Middle Name:
Last Name:SONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COMMANDER 18TH MEDICAL COMMAND
Mailing Address - Street 2:ATTN FAMC DCCS QM CRODA
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96205
Mailing Address - Country:KR
Mailing Address - Phone:315-736-6097
Mailing Address - Fax:315-737-8110
Practice Address - Street 1:121ST COMBAT SUPPORT HOSPITAL
Practice Address - Street 2:DEPT OF SURGERY
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96205
Practice Address - Country:KR
Practice Address - Phone:315-737-6611
Practice Address - Fax:315-737-8110
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094064208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery