person
Myung Ae Song, DO,MBA
General Practice Physician in Boise, Idaho
NPI 1922130541

Myung Ae Song is a General Practice Physician based in Nampa, ID. Myung Ae Song practices in Boise, ID and has the professional credentials of DO,MBA. The NPI Number for Myung Ae Song is 1922130541 and holds a License No. O-322 (Idaho).

The current practice location address for Myung Ae Song is 8950 W Emerald St, Boise, ID and can be reached out via phone at 208-901-5144.

Location: 8950 W Emerald St, Boise, ID, 83686-7806
person
Provider Profile Details
NPI Number
1922130541
Provider Name
Myung Ae Song
Credential
DO,MBA
Provider Entity Type
Individual
Gender
Female
Address
8950 W Emerald St, Boise, ID, 83686-7806
Phone Number
208-901-5144
Fax Number
Provider Enumeration Date
03/09/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
CS-10302 01 ID IDAHO CONTROLLED SUBSTANC
H06991 01 ID UPIN #
O-322 01 ID IDAHO MEDICAL LICENSE
institution
Provider Business Practice Location Address Details
Address
8950 W Emerald St
City
State
Zip
83704-8296
Phone Number
208-901-5144
Fax Number
person
Provider Business Mailing Address Details
Address
8950 W Emerald St
City
State
Zip
83704-8296
Phone Number
208-901-5144
Fax Number
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
General Practice
Speciality
-
Taxonomy
License No.
O-322 (Idaho)
Definition
Definition to come...
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