Provider Demographics
NPI:1922008879
Name:SONG, WOO KWANG (MD)
Entity Type:Individual
Prefix:DR
First Name:WOO
Middle Name:KWANG
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 1:1458 W LANDIS AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-3427
Mailing Address - Country:US
Mailing Address - Phone:856-691-2552
Mailing Address - Fax:856-691-8885
Practice Address - Street 1:1458 W LANDIS AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-3427
Practice Address - Country:US
Practice Address - Phone:856-691-2552
Practice Address - Fax:856-691-8885
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04574900207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5583501Medicaid
NJF61573Medicare UPIN