Provider Demographics
NPI:1295721777
Name:SONG, JINSUP (DPM PHD)
Entity type:Individual
Prefix:DR
First Name:JINSUP
Middle Name:
Last Name:SONG
Suffix:
Gender:M
Credentials:DPM PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TEMPLE UNIVERSITY FOOT AND ANKLE INSTITUTE PO BOX 22433
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-2433
Mailing Address - Country:US
Mailing Address - Phone:215-777-5808
Mailing Address - Fax:215-777-5716
Practice Address - Street 1:148 N 8TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-2496
Practice Address - Country:US
Practice Address - Phone:215-777-5808
Practice Address - Fax:215-777-5825
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004393L213E00000X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018076090003Medicaid
NJ8259607OtherNJ MEDICAL ASSISTANCE
PA893038OtherKEYSTONE HEALTH PLAN PPO
PA1125735OtherKEYSTONE MERCY
PA231365971OtherHUMANA
PA1807609Medicaid
PAP2665731OtherOXFORD
PA0499950000OtherKEYSTONE HEALTH PLAN HMO
PA231365971071OtherTRI-CARE
PAS0819326OtherBLUE SHIELD OF PA
PA231365971OtherUNITED HEALTH CARE
PA9231OtherELDER HEALTH / BRAVO
PAH19826OtherINTER-CITY
PA2353876OtherAETNA
PA28824OtherHEALTH PARTNERS
PA480030054OtherRAILROAD MEDICARE
PA3Y2326OtherHEALTH NET
PA435767OtherHEALTH AMERICA HEALTH ASSURANCE
U79866Medicare UPIN
NJ8259607OtherNJ MEDICAL ASSISTANCE