Song, Gina K.

Song, Gina K. is an individual health care provider with primary practice located at 2455 Dean St Suite A, St Charles IL 60175-4830. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Song, Gina K. can be contacted via phone (630) 513-9160.

Contact Information

Primary practice address
2455 Dean St Suite A St Charles IL 60175-4830
Phone: (630) 513-9160
Fax: (630) 513-9617
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 036104024 Illinois

Profile Details

NPI number 1386642445
LBN Legal business name Song, Gina K.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 12th, 2005
Last updated Dec 28th, 2009 - about 15 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 1386642445 NPPES
Illinois Other 4532123 BCBS
Illinois MEDICAID 036104024 BCBS

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