Provider Demographics
NPI:1952512808
Name:KAO, YU SONG (MD)
Entity Type:Individual
Prefix:DR
First Name:YU SONG
Middle Name:
Last Name:KAO
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 1:166 HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-3544
Mailing Address - Country:US
Mailing Address - Phone:570-829-6644
Mailing Address - Fax:570-829-6446
Practice Address - Street 1:166 HANOVER ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-3544
Practice Address - Country:US
Practice Address - Phone:570-829-6644
Practice Address - Fax:570-829-6446
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 017676E2084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019671780001Medicaid
PAKA137105OtherBLUE SHIELD
PA137105Medicare PIN
PA1019671780001Medicaid