1700846367 NPI number — SONG HAI NAM CHAE MD

Table of content: SONG HAI NAM CHAE MD (NPI 1700846367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700846367 NPI number — SONG HAI NAM CHAE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAE
Provider First Name:
SONG HAI
Provider Middle Name:
NAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700846367
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 32615
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48232-0615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-593-7965
Provider Business Mailing Address Fax Number:
313-593-7143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10000 SOUTH TELEGRAPH ROAD
Provider Second Line Business Practice Location Address:
HERITAGE HOSPITAL
Provider Business Practice Location Address City Name:
TAYLOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48180-3330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-295-5000
Provider Business Practice Location Address Fax Number:
313-295-5373
Provider Enumeration Date:
03/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  032355 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4417447 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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