Provider Demographics
NPI:1952982183
Name:SONG, DA YOUNG (MD)
Entity type:Individual
Prefix:DR
First Name:DA YOUNG
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 1:21202 OWENS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-2038
Mailing Address - Country:US
Mailing Address - Phone:779-334-0020
Mailing Address - Fax:779-334-0021
Practice Address - Street 1:21202 OWENS RD STE 201
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-2038
Practice Address - Country:US
Practice Address - Phone:779-334-0020
Practice Address - Fax:779-334-0021
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.170906207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine