Woo Kwang Song MD Gastroenterology LLC

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

25MA04574900 Issued in NJ

Legal business name

WOO KWANG SONG MD GASTROENTEROLOGY LLC

Practice address

1458 W Landis Ave
Suite 1
Vineland, NJ 08360-3427

Phone

(856) 691-2552

Fax

(856) 691-8885

NPI assigned

Jun 11, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Woo Kwang Song, MD

Title

Physician

Phone

(856) 691-2552

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285718400000",
    "number": "1316989759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1458 W LANDIS AVE",
            "address_2": "SUITE 1",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083603427",
            "telephone_number": "856-691-2552",
            "fax_number": "856-691-8885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1458 W LANDIS AVE",
            "address_2": "SUITE 1",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083603427",
            "telephone_number": "856-691-2552",
            "fax_number": "856-691-8885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOO KWANG SONG MD GASTROENTEROLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2010-09-29",
        "status": "A",
        "authorized_official_last_name": "SONG",
        "authorized_official_first_name": "WOO",
        "authorized_official_middle_name": "KWANG",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "856-691-2552",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NJ",
            "license": "25MA04574900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5583501",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Gastroenterology Physician in Vineland, NJ
• Providers in Vineland, NJ by specialty
• Gastroenterology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2010; 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.