Sun Young Song

Primary specialty

DentistTaxonomy code 122300000X

License

2022021331 Issued in MO

Practice address

Uss Osbourne, Building 1017
Nmrtc Great Lakes
North Chicago, IL 60064

Phone

(847) 688-2100

NPI assigned

Jun 27, 2022

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

Other names 1

• Sun Youg Song Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1656288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656288000000",
    "number": "1417689761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3909 GALLANT FOX DR",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652024831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "USS OSBOURNE, BUILDING 1017",
            "address_2": "NMRTC GREAT LAKES",
            "city": "NORTH CHICAGO",
            "state": "IL",
            "postal_code": "60064",
            "telephone_number": "847-688-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "SUN YOUNG",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-27",
        "last_updated": "2022-06-27",
        "certification_date": "2022-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2022021331",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUN YOUG",
            "last_name": "SONG",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Michael Smirnov, M.D
• Susan Ashley Smith, LCSW
• Elizabeth Snider
• Oleksiy Solonowicz
• Charles Sommercorn, R.PH.
• Kassondra Soto, LCSW
• Selly Soto, MD
• Joseph William Spellman, MD
• Catherine A. Spillner, MSW
• Ilana Nicole Spitz

• Dentist in North Chicago, IL
• Providers in North Chicago, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2022; 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.