Provider Demographics
NPI:1295766756
Name:TU, SONG-YIH (MD)
Entity type:Individual
Prefix:
First Name:SONG-YIH
Middle Name:
Last Name:TU
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 1:322 RIDGE RESERVE DR
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-6922
Mailing Address - Country:US
Mailing Address - Phone:803-831-1031
Mailing Address - Fax:
Practice Address - Street 1:701 GROVE RD
Practice Address - Street 2:CAROLINA EMERGENCY MEDICINE
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5611
Practice Address - Country:US
Practice Address - Phone:864-455-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2012-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07819300207P00000X
SC30459207P00000X
NC2008-01886207P00000X
NY207860207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0059331Medicaid
NJ0059331Medicaid
G69561Medicare UPIN