Active NPI
Edward Hanuk Song, D.M.D.
- Endodontics
- Kenosha, WI
National Provider Identifier
1437438769
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 1002174-15
- Practice address
- 7500 Green Bay Rd Ste 200
Kenosha, WI 53142-4045 - Phone
- (262) 842-7022
- NPI assigned
- Aug 4, 2011
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 1002174-15 | WI | Primary |
Addresses
Primary practice location
7500 Green Bay Rd Ste 200
Kenosha, WI 53142-4045
Mailing address
7500 Green Bay Rd Ste 200
Kenosha, WI 53142-4045
Phone (262) 842-7022
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1002174-15 | WI | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1759795200000",
"number": "1437438769",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7500 GREEN BAY RD STE 200",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531424045",
"telephone_number": "262-842-7022"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7500 GREEN BAY RD STE 200",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531424045",
"telephone_number": "262-842-7022"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SONG",
"first_name": "EDWARD",
"middle_name": "HANUK",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-08-04",
"last_updated": "2025-10-07",
"certification_date": "2025-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "WI",
"license": "1002174-15",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kenosha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.