Individual
LEONARD KYUNGSUP SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1120 W MICHIGAN ST # CL630, INDIANAPOLIS, IN 46202-5209
(317) 278-2689
Mailing address
1120 W MICHIGAN ST # CL630, INDIANAPOLIS, IN 46202-5209
(317) 278-2689
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
11020473A
IN
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/14/2019
Last updated
11/28/2025
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