NPIMap

Individual provider Active NPI

Chaewon Song, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Garden Grove, CA
National Provider Identifier
1972589687
Registry record updated Nov 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
C52295 Issued in CA
Practice address
12665 Garden Grove Blvd
Suite 503
Garden Grove, CA 92843-1901
Phone
(714) 530-3740
Fax
(714) 530-0582
NPI assigned
Dec 15, 2005
Last updated
Nov 7, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 7, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X C52295 CA Primary

Addresses

Primary practice location

12665 Garden Grove Blvd
Suite 503
Garden Grove, CA 92843-1901

Mailing address

12665 Garden Grove Blvd
Suite 503
Garden Grove, CA 92843-1901
Phone (714) 530-3740

Other identifiers 1

IdentifierTypeStateIssuer
001397430MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070117000542 CA Practitioner - Internal MedicinePractitioner - Geriatric Medicine 4688661549 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

12665 Garden Grove Blvd
Garcen Grove, CA 92843-1919
Phone (714) 534-6516

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C52295CAMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Chaewon Song, MD, Inc Geriatric Medicine CurrentSince Dec 1, 2006 Accepting new patients
Song Medical Group Inc CurrentSince Jan 2, 2025 Accepting new patients
St Jude Hospital Inc Past Accepting new patients
Yale New Haven Hospital Past Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients
Lawrence and Memorial Hospital, Inc. Past Accepting new patients
Masonicare Primary Care Physicians Geriatric Medicine PastSince Oct 1, 2001 Accepting new patients
Orange County Global Medical Center, Inc Past Accepting new patients
Masonicare Behavioral Health, LLC PastSince Dec 17, 2007 Accepting new patients

Locations

12665 Garden Grove Blvd
Garden Grove, CA 92843
Phone (714) 537-5302

12665 Garden Grove Blvd
Ste 503
Garden Grove, CA 92843
Phone (714) 530-3740

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Greenfield Care Center of Fullerton, LLCFullerton, CA, CCN 056151 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 May 14, 2010
May 14, 2010
Sun Mar Nursing CenterAnaheim, CA, CCN 555266 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2007
Jan 1, 2007
The Grove Post AcuteGarden Grove, CA, CCN 555021 Skilled nursing facility Adp of the SNF Jun 30, 2025

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 10

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.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1134604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383782400000",
    "number": "1972589687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12665 GARDEN GROVE BLVD",
            "address_2": "SUITE 503",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431901",
            "telephone_number": "714-530-3740",
            "fax_number": "714-530-0582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12665 GARDEN GROVE BLVD",
            "address_2": "SUITE 503",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431901",
            "telephone_number": "714-530-3740",
            "fax_number": "714-530-0582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SONG",
        "first_name": "CHAEWON",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-15",
        "last_updated": "2013-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "C52295",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001397430",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden Grove, CA

Sources for this page

Verify at the official NPI Registry.