Provider Demographics
NPI:1750404380
Name:SONG, RUI (MD)
Entity type:Individual
Prefix:
First Name:RUI
Middle Name:
Last Name:SONG
Suffix:
Gender:F
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:PO BOX 203268
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-3268
Mailing Address - Country:US
Mailing Address - Phone:281-586-0834
Mailing Address - Fax:281-586-0923
Practice Address - Street 1:17080 RED OAK DRIVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2602
Practice Address - Country:US
Practice Address - Phone:281-586-0834
Practice Address - Fax:281-586-0923
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA546742085R0202X
TXN33212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202331902Medicaid
TX202331902Medicaid