| Doctor Name: | MYUNG AE SONG |
| NPI Number: | 1922130541 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DO |
| License Number: | O-322 |
| Business Practice Address: | 486 West First Avenue Glenns Ferry, ID - 836230266 |
| Business Phone Number: | 2083667416 |
| Business Fax Number: | 2083662595 |
| Mailing Address: | 12706 Deer Ridge Trl, NAMPA |
| State: | ID |
| Postal Code: | 836867806 |
| Phone Number: | 2084612790 |
| Fax Number: | |
| NPI Enumeration Date: | 03/09/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204D00000X |
| License Number: | O-322 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Neuromusculoskeletal Medicine & OMM |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |