Myung Ae Song, D.O. , M.B.A.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

O-322 Issued in ID

Practice address

8950 W Emerald St
Ste 168
Boise, ID 83704-8296

Phone

(208) 901-5144

NPI assigned

Mar 9, 2007

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Osteopathy, Master of Business Administration, Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Page Hospital

  • Critical Access Hospital
  • Page, AZ
  • NPI 1578515789
  NPD (past)

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1922130541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12706 DEER RIDGE TRL",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836867806",
            "telephone_number": "208-901-5144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8950 W EMERALD ST",
            "address_2": "STE 168",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048296",
            "telephone_number": "208-901-5144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "MYUNG",
        "middle_name": "AE",
        "credential": "D.O. , M.B.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-09",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "ID",
            "license": "O-322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO MEDICAL LICENSE",
            "identifier": "O-322",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN #",
            "identifier": "H06991",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO CONTROLLED SUBSTANC",
            "identifier": "CS-10302",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• John R Sonntag, M.D.
• Paul David Sonntag, MD
• Sonshine Family Health Clinic, LLC

• General Practice Physician in Boise, ID
• Providers in Boise, ID by specialty
• General Practice Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.