Individual
DR. SEUNG-JAE TEXAS SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
6286 BRIARCREST AVE STE 120, MEMPHIS, TN 38120-4023
(901) 259-1600
(901) 259-1698
Mailing address
6077 PRIMACY PKWY STE 140, MEMPHIS, TN 38119-5754
(901) 259-1673
(901) 259-7637
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
753
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
753
LICENSE
TN
01
—
T83001A
MEDICARE
TN
Enumeration date
08/18/2011
Last updated
11/22/2022
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