Individual
SEUNGJAI NANCY SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
200 PATEWOOD DR, SUITE A120, GREENVILLE, SC 29615-3593
(864) 454-2670
(864) 454-2679
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
20268
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0820881
CIGNA ID
SC
05
—
202685
—
SC
01
—
370017230
RR MEDICARE
SC
01
—
571004971024
BCBS OF SC ID
SC
01
—
571004971027
BLUECHOICE HEALTHPLAN ID
SC
01
—
7926193
AETNA ID
SC
Enumeration date
06/15/2006
Last updated
05/19/2021
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