Individual
MRS. GINA K. SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2455 DEAN ST, SUITE A, ST CHARLES, IL 60175-4830
(630) 513-9160
(630) 513-9617
Mailing address
2455 DEAN ST, SUITE A, ST CHARLES, IL 60175
(630) 513-9160
(630) 513-9617
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036104024
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036104024
—
IL
01
—
4532123
BCBS
IL
Enumeration date
07/12/2005
Last updated
12/28/2009
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