# MYUNG AE SONG

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1922130541
- **Gender:** F
- **Credential:** D.O. , M.B.A.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | O-322 | ID | Yes |

## Other

- **Enumeration date:** 03/09/2007
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | CS-10302 | IDAHO CONTROLLED SUBSTANC | ID |
| 01 | — | H06991 | UPIN \# | ID |
| 01 | — | O-322 | IDAHO MEDICAL LICENSE | ID |