Individual provider Active NPI

Sharon Kyungha Song, D.M.D.

  • General Practice Dentistry
  • Norwalk, CT
National Provider Identifier
1053452359
Registry record updated Aug 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
009859 Issued in CT
Practice address
49 Day St
Norwalk, CT 06854-4901
Phone
(203) 854-9292
Fax
(203) 854-9437
NPI assigned
Feb 9, 2007
Last updated
Aug 9, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 0520021 NY
General Practice Dentistry 1223G0001X 009859 CT Primary

Addresses

Primary practice location

49 Day St
Norwalk, CT 06854-4901

Mailing address

635 Main St
Attn: Credentialing Dept
Middletown, CT 06457-2718
Phone (860) 347-6971

Other identifiers 2

IdentifierTypeStateIssuer
02678297MedicaidNY
004236354MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20201123001927 CT Order and Referring Only - DentistPractitioner - Dentist 8022429083

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
009859CTMDGeneral Practice Dentistry
0520021NYMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Center Inc Past Accepting new patients
Community Health Center Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: sharon.song@chcict.eclinicaldirectplus.com

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312848000000",
    "number": "1053452359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 MAIN ST",
            "address_2": "ATTN: CREDENTIALING DEPT",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064572718",
            "telephone_number": "860-347-6971",
            "fax_number": "860-638-6601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 DAY ST",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068544901",
            "telephone_number": "203-854-9292",
            "fax_number": "203-854-9437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "SHARON",
        "middle_name": "KYUNGHA",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-09",
        "last_updated": "2011-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "0520021",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "009859",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02678297",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004236354",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norwalk, CT

Sources for this page

Verify at the official NPI Registry.