Gi Suk Song, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

170312-1 Issued in NY

Practice address

105 Marys Ave
Kingston, NY 12401

Phone

(845) 338-2500

Fax

(845) 338-5616

NPI assigned

Jul 11, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526947200000",
    "number": "1114952066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2270",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124022270",
            "telephone_number": "845-339-7582",
            "fax_number": "845-336-5616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 MARYS AVE",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "12401",
            "telephone_number": "845-338-2500",
            "fax_number": "845-338-5616"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "396 Broadway",
            "address_purpose": "LOCATION",
            "city": "Kingston",
            "state": "NY",
            "postal_code": "124014626",
            "country_code": "US",
            "telephone_number": "845-331-3131",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "42084 State Highway 28",
            "address_purpose": "LOCATION",
            "city": "Margaretville",
            "state": "NY",
            "postal_code": "124552820",
            "country_code": "US",
            "telephone_number": "845-586-2631",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SONG",
        "first_name": "GI",
        "middle_name": "SUK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2018-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "170312-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01232508",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Diagnostic Radiology Physician in Kingston, NY
• Providers in Kingston, NY by specialty
• Diagnostic Radiology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.