Qiujing Song, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019030694 Issued in IL

Practice address

6070 State Route 53
Lisle, IL 60532-3395

Phone

(630) 963-4306

Fax

(630) 963-9344

NPI assigned

Jun 30, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• New Life Wellness Inc

  • General Practice Dentistry
  • Plainfield, IL
  • NPI 1184320566
  NPD Authorized official

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

{
    "created_epoch": "1467244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676246400000",
    "number": "1265883292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6070 STATE ROUTE 53",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605323395",
            "telephone_number": "630-963-4306",
            "fax_number": "630-963-9344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6070 STATE ROUTE 53",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605323395",
            "telephone_number": "630-963-4306",
            "fax_number": "630-963-9344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "QIUJING",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-30",
        "last_updated": "2023-02-13",
        "certification_date": "2023-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019030694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tryn Smith, PA
• Claire Marie Smolinski, LMT
• Snow Valley Nursing and Rehabilitation Center, LLC
• Marc Solodky, LPC
• Megan M Sommerfield, M.S.
• Celeste Adele Sorensen, LCSW
• Danielle Marie Southerland, DO
• Southwest Hearing Solutions Inc
• Sovereign Pediatric
• Specialized Pediatric Occupational Therapy Services, LLC

• General Practice Dentistry in Lisle, IL
• Providers in Lisle, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2023; 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.