Individual provider Active NPI

Joung Eun Song, DDS

  • General Practice Dentistry
  • Glenview, IL
National Provider Identifier
1023255783
Registry record updated Jan 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019-023678 Issued in IL
Practice address
2640 Patriot Blvd Ste 230
Glenview, IL 60026-8075
Phone
(847) 724-0980
Fax
(847) 724-0981
NPI assigned
Jan 15, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019-023678 IL Primary

Addresses

Primary practice location

2640 Patriot Blvd Ste 230
Glenview, IL 60026-8075

Mailing address

2640 Patriot Blvd Ste 230
Glenview, IL 60026-8075
Phone (847) 724-0980

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160906000218 IL Order and Referring Only - DentistPractitioner - Dentist 7315233152

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019-023678ILMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Joung Eun Song, DDS, PC General Practice Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1231977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1231977600000",
    "number": "1023255783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2640 PATRIOT BLVD STE 230",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600268075",
            "telephone_number": "847-724-0980",
            "fax_number": "847-724-0981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2640 PATRIOT BLVD STE 230",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600268075",
            "telephone_number": "847-724-0980",
            "fax_number": "847-724-0981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "JOUNG",
        "middle_name": "EUN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-15",
        "last_updated": "2009-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-023678",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glenview, IL

Sources for this page

Verify at the official NPI Registry.