Individual
SONG KANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
320 E CENTRAL AVE, DECATUR, IL 62521-4665
(217) 877-4694
Mailing address
3727 N NORTHHAVEN CT APT 2A, DECATUR, IL 62526-9250
(618) 201-9860
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
085006761
IL
363AM0700X
Medical Physician Assistant
Primary
085006761
IN
Other
Enumeration date
10/01/2018
Last updated
10/10/2018
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