Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 20958 | SC |
NPI | 1770569105 |
---|---|
Provider Name | Dr. Young Sug Song |
First Address | Mount Pleasant, SC 29464-9545 |
Second Address | Mount Pleasant, SC 29464-9545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2005 |
Last Update Date | 07/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H54558 | (02) | SC |