Chang Ki Song is a Vascular Surgery in Peoria, Illinois. Chang Ki Song practices all healthcare services and medical treatments related to Vascular Surgery. The NPI Number for Chang Ki Song is 1609892728. The last update date is 2008-12-05.
Chang Ki Song's current location address is 5401 N Knoxville Ave, Peoria, Illinois. You can contact this provider via phone number 3096911092 and fax number 3096896092. The mailing address for Chang Ki Song is 5401 N Knoxville Ave, Peoria, Illinois. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Chang Ki Song |
|---|---|
| Address | 5401 N Knoxville Ave, Peoria, Illinois |
| Phone Number | 3096911092 |
| Fax Number | 3096896092 |
| Sole Proprietor | Y |
| Credentials | MD |
NPI Number Detail
| NPI Number | 1609892728 |
|---|---|
| Provider Enumeration Date | 2006-07-14 |
| Last Updated Date | 2008-12-05 |
Provider Mailing Address Detail
| Address | 5401 N Knoxville Ave |
|---|---|
| City | Peoria |
| State | Illinois (IL) |
| Post Code | 616145098 |
| Phone Number | 3096911092 |
| Fax Number | 3096896092 |
Provider's Primary Taxonomy Detail
| Speciality | Vascular Surgery |
|---|---|
| Taxonomy | 2086S0129X |
| Licence No | 36060265 |
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Definition: A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 36060265 | IL | -- | |
| 7221997 | IL | BLUE CROSS BLUE SHIELD |
Post Comment/ Review Below
What is the unique identification code assigned to Chang Ki Song by the Centers for Medicare & Medicaid Services?
The Chang Ki Song has been issued the NPI (National Provider Identifier) 1609892728. This 10-digit code serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you provide the complete physical address where Chang Ki Song is located?
The Chang Ki Song is situated at the following address: 5401 N Knoxville Ave, Peoria, IL, 616145098.
What is the Chang Ki Song's specialty and taxonomy code?
The Chang Ki Song's specialty is Vascular Surgery, and the corresponding taxonomy code is 2086S0129X.
When did Chang Ki Song receive its 1609892728 assignment?
The Chang Ki Song was assigned its 1609892728 on 2006-07-14, which is the date when this unique identifier was issued to the organization.
When was the information related to Chang Ki Song most recently updated or refreshed?
The details pertaining to the Chang Ki Song, including its address, specialty, and other relevant information, were last updated or refreshed on 2008-12-05.