| Chaewon Song, Md, Inc | |
|
12665 Garden Grove Blvd Suite 503 Garden Grove CA 92843-1901 | |
| (714) 534-6516 | |
| (714) 530-0582 |
| Full Name | Chaewon Song, Md, Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 12665 Garden Grove Blvd, Garden Grove, California |
| Authorized Official Name and Position | Chaewon Song (M.D.) |
| Authorized Official Contact | 7145346516 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chaewon Song, Md, Inc 12665 Garden Grove Blvd Suite 503 Garden Grove CA 92843-1901 Ph: (714) 534-6516 | Chaewon Song, Md, Inc 12665 Garden Grove Blvd Suite 503 Garden Grove CA 92843-1901 Ph: (714) 534-6516 |
| NPI Number | 1265502017 |
|---|---|
| Provider Enumeration Date | 11/09/2006 |
| Last Update Date | 11/07/2013 |
| Medicare PECOS PAC ID | 6608877618 |
|---|---|
| Medicare Enrollment ID | O20070117000544 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265502017 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | C52295 (California) | Primary |
| Provider Name | Chaewon Song |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972589687 PECOS PAC ID: 4688661549 Enrollment ID: I20070117000542 |
| Provider Name | Shieun Hong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922467299 PECOS PAC ID: 2769854587 Enrollment ID: I20230203002172 |
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