Provider Demographics
NPI:1619550779
Name:SONG, SEUNG GON (PT)
Entity Type:Individual
Prefix:MR
First Name:SEUNG GON
Middle Name:
Last Name:SONG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135-25F 79TH STREET
Mailing Address - Street 2:MEDICAL NOW, SUITE 2A
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414
Mailing Address - Country:US
Mailing Address - Phone:718-296-3600
Mailing Address - Fax:
Practice Address - Street 1:32 CAMPUS DR.
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:58981
Practice Address - Country:US
Practice Address - Phone:917-640-4213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program