Active NPI
Hwe Jae Song, M.D.
- Pediatric Anesthesiology Physician
- Green Bay, WI
National Provider Identifier
1235344730
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Anesthesiology Physician
- License
- 19404-020
- Practice address
- 139 Garden Gate CT
Green Bay, WI 54313-4703 - Phone
- (920) 883-9527
- NPI assigned
- May 10, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatric Anesthesiology Physician | 207LP3000X | 19404-020 | WI | Primary |
Addresses
Primary practice location
139 Garden Gate CT
Green Bay, WI 54313-4703
Mailing address
139 Garden Gate CT
Green Bay, WI 54313-4703
Phone (920) 883-9527
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 |
|---|---|---|---|
| 19404-020 | WI | MD | Pediatric Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1235344730",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "139 GARDEN GATE CT",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543134703",
"telephone_number": "920-883-9527"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "139 GARDEN GATE CT",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543134703",
"telephone_number": "920-883-9527"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SONG",
"first_name": "HWE",
"middle_name": "JAE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207LP3000X",
"taxonomy_group": "",
"desc": "Anesthesiology, Pediatric Anesthesiology",
"state": "WI",
"license": "19404-020",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.