Provider Demographics
NPI:1609241827
Name:CHI, SONG-HWI
Entity Type:Individual
Prefix:
First Name:SONG-HWI
Middle Name:
Last Name:CHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 DAYTON XENIA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-6393
Mailing Address - Country:US
Mailing Address - Phone:937-427-2225
Mailing Address - Fax:937-405-1078
Practice Address - Street 1:3060 DAYTON XENIA RD
Practice Address - Street 2:SUITE A
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-6393
Practice Address - Country:US
Practice Address - Phone:937-427-2225
Practice Address - Fax:937-405-1078
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000110171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist