Individual
GRACE SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10139 ROYALTON RD STE H, NORTH ROYALTON, OH 44133-4473
(440) 816-2878
Mailing address
PO BOX 638269, CINCINNATI, OH 45263-8269
(440) 816-2878
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35082229S
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2425807
—
OH
Enumeration date
10/26/2006
Last updated
02/22/2022
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