Provider Demographics
NPI:1912927625
Name:YU, SONG IL (MD)
Entity Type:Individual
Prefix:
First Name:SONG
Middle Name:IL
Last Name:YU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 W LAKESHORE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-7271
Mailing Address - Country:US
Mailing Address - Phone:205-547-3996
Mailing Address - Fax:202-438-7151
Practice Address - Street 1:5915 CHALKVILLE MOUNTAIN RD STE 110
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3354
Practice Address - Country:US
Practice Address - Phone:205-547-3920
Practice Address - Fax:205-547-3925
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2023-08-16
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Provider Licenses
StateLicense IDTaxonomies
AL00027603207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALI61378Medicare UPIN