Individual
SANG SONG
Active
Individual
SANG SONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD03172L
PA
207ZC0006X
Clinical Pathology Physician
Primary
MD03172L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000953068 0003
—
PA
01
—
0023022000
IBC
PA
01
—
141292
HIGHMARK BLUE SHIELD
PA
01
—
34005B
KEYSTONE MERCY
PA
Enumeration date
06/06/2006
Last updated
02/25/2008
Update your record
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