Provider Demographics
NPI:1598779993
Name:SONG, WON G (MD)
Entity Type:Individual
Prefix:MR
First Name:WON
Middle Name:G
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 1:1430 SOUTH HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207
Mailing Address - Country:US
Mailing Address - Phone:614-443-0583
Mailing Address - Fax:614-443-2528
Practice Address - Street 1:1430 SOUTH HIGH STREET
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207
Practice Address - Country:US
Practice Address - Phone:614-443-0583
Practice Address - Fax:614-443-2528
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSO0427842207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
31-1021393-00OtherFEDERAL TAX ID# WITH BWC
OH0344685Medicaid
SO0427842Medicare ID - Type Unspecified
31-1021393-00OtherFEDERAL TAX ID# WITH BWC