Active NPI
Chull Sung Song, MD
- Diagnostic Radiology Physician
- Tracy, CA
National Provider Identifier
1154312668
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- G13535
- Practice address
- 1530 Bessie Ave
Ste 108
Tracy, CA 95376-3080 - Phone
- (209) 342-2300
- Fax
- (209) 524-4240
- NPI assigned
- Nov 3, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | G13535 | CA | Primary |
Addresses
Primary practice location
1530 Bessie Ave
Ste 108
Tracy, CA 95376-3080
Mailing address
4301 Northstar Way
Modesto, CA 95356-9262
Phone (209) 342-2300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OOG135350 | Other | CA | BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G13535 | CA | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Radiology Consultants Medical Group, Inc | Diagnostic Radiology | 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.
-
- Diagnostic Radiology Physician
- Stockton, CA
- NPI 1669463675
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1201478400000",
"number": "1154312668",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4301 NORTHSTAR WAY",
"city": "MODESTO",
"state": "CA",
"postal_code": "953569262",
"telephone_number": "209-342-2300",
"fax_number": "209-524-4240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1530 BESSIE AVE",
"address_2": "STE 108",
"city": "TRACY",
"state": "CA",
"postal_code": "953763080",
"telephone_number": "209-342-2300",
"fax_number": "209-524-4240"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SONG",
"first_name": "CHULL",
"middle_name": "SUNG",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-03",
"last_updated": "2008-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "CA",
"license": "G13535",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "OOG135350",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tracy, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.