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DR. CHANG KI SONG MD NPI 1609892728


NPI Information

NPI: 1609892728
Provider Name: DR. CHANG KI SONG, MD
Classification: Surgery - 208600000X
Entity Type: Individual
Address:
5401 N KNOXVILLE AVE
SUITE 217
PEORIA, IL
ZIP 61614
Phone: (309) 691-1092
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DR. Chang Ki Song, MD is a surgery in Peoria, IL. The provider is a general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. DR. Chang Ki Song, MD NPI is 1609892728. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

5401 N KNOXVILLE AVE
SUITE 217
PEORIA, IL
ZIP 61614-098
Phone: (309) 691-1092
Fax: (309) 689-6092

The enumeration date for this NPI number is 7/14/2006 and was last updated on 12/5/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
12086S0129XSurgeryVascular Surgery036060265ILLINOISNo
2208600000XSurgery036060265ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
107221997OTHERILLINOISBLUE CROSS BLUE SHIELD
2C03578MEDICARE UPIN
3371366500OTHEREIN
4036060265MEDICAIDILLINOIS
5399880MEDICARE ID-TYPE UNSPECIFIED

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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