Individual
DR. JAEKYUNG SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
914 S SCHEUBER RD, CENTRALIA, WA 98531
(360) 330-8976
Mailing address
PO BOX 3360, PORTLAND, OR 97208-3360
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD60377532
WA
208M00000X
Hospitalist Physician
MD60377532
WA
Other
Enumeration date
06/27/2007
Last updated
06/06/2018
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