Song, Chang Ki

Song, Chang Ki is an sole proprietor health care provider with primary practice located at 5401 N Knoxville Ave Suite 217, Peoria IL 61614-5098. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Vascular Surgery. Allopathic & Osteopathic Physicians / Surgery is his primary health care specialty. Song, Chang Ki can be contacted via phone (309) 691-1092.

Contact Information

Primary practice address
5401 N Knoxville Ave Suite 217 Peoria IL 61614-5098
Phone: (309) 691-1092
Fax: (309) 689-6092
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 036060265 Illinois
Allopathic & Osteopathic Physicians / Vascular Surgery 2086S0129X 036060265 Illinois

Profile Details

NPI number 1609892728
LBN Legal business name Song, Chang Ki
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 14th, 2006
Last updated Dec 5th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609892728 NPPES
Illinois MEDICAID 036060265
Illinois Other 07221997

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