DR. JAEKYUNG SONG (NPI# 1972700656) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972700656 |
| Entity Type | Individual |
| Full Name | DR. JAEKYUNG SONG |
| Credential | M.D. |
| Practice Address |
914 S Scheuber Rd Centralia WA 98531 |
| Mailing Address |
Po Box 3360 Portland OR 97208-3360 |
| Practice Telephone | 3603308976 |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2018-06-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | MD60377532 | WA | Allopathic & Osteopathic Physicians |
| N | 208M00000X | Hospitalist | MD60377532 | WA | Allopathic & Osteopathic Physicians |
| Street Address |
914 S SCHEUBER RD |
| City | CENTRALIA |
| State | WA |
| Zip Code | 98531 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982600805 | Leena Carriere | Anesthesiology | 914 S Scheuber Rd, Pmg Sw Wa Centralia Anesthesiology, Centralia, WA 98531-9027 | 2005-06-24 |
| 1114542065 | Gary John Clinton Mersereau Sr. | Registered Nurse | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2020-06-16 |
| 1366077745 | Andrew J Maasdam | Nurse Anesthetist, Certified Registered | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2020-03-06 |
| 1447884374 | Michelle Stover | Registered Nurse | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2020-02-29 |
| 1932748993 | Erika Anne Laurentz | Counselor | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2019-12-22 |
| 1952942567 | Ashley Marie Wheeler | Emergency Medicine | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2019-10-04 |
| 1619537057 | Rebecca Kathryn Mcneil | Counselor | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2019-06-18 |
| 1982269395 | Jennifer Green | Physician Assistant | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2019-05-01 |
| 1033698519 | Jennifer Ann Reuter | Physician Assistant | 914 S Scheuber Rd, Centralia, WA 98531 | 2018-08-07 |
| 1629554274 | Rachelle Marie Peterson | Occupational Therapist | 914 S Scheuber Rd, Centralia, WA 98531-9027 | 2018-07-17 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306462205 | Jelisa Renae Thomas | Counselor | 3510 Steelhammer Ln, Centralia, WA 98531 | 2020-06-17 |
| 1205498607 | Jennifer Kristine Mcglynn Paterno | Counselor | 2428 W. Reynods Ave, Centralia, WA 98531 | 2019-07-05 |
| 1538646328 | Adam Jeffrey Moore | Counselor | 3510 Steelhammer Lane, Centralia, WA 98531 | 2018-07-24 |
| 1144706698 | Euijeong Kim | Occupational Therapist | Rehabilitation Therapies, 914 S. Scheuber Rd, Centralia, WA 98531 | 2018-07-18 |
| 1104315266 | Margaret Fowler Floyd | Registered Nurse | Centralia High School, 813 Eshom Road, Centralia, WA 98531 | 2018-05-04 |
| 1124545777 | Samantha Michelle Moody | Speech-Language Pathologist | Centralia School District, 2320 Borst Ave, Centralia, WA 98531 | 2017-08-24 |
| 1821520289 | Alexa Franks | Behavior Technician | 2428 West Reynolds Ave., Centralia, WA 98531 | 2017-04-03 |
| 1023559861 | Brandy Michelle Peterson | Counselor | 135 W. Main Steet, Centralia, WA 98531 | 2017-03-13 |
| 1841738812 | Graceful Healing Naturopathic | Naturopath | 219 N Tower Ave, Suite 304, Centralia, WA 98531 | 2017-02-09 |
| 1043681513 | Angela Naillon | Counselor | 2428 West Reynolds, Centralia, WA 98531 | 2015-10-09 |
| Find all providers in zip 98531 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073810354 | Tom Martin Md Sc | Internal Medicine | 1050 Ml King Dr, Suite 104, Centralia, IL 62801-3060 | 2011-02-22 |
| 1518132489 | Gibran Hamid Mahmud | Internal Medicine | 1052 M L King Dr, Suite 2, Centralia, IL 62801-3002 | 2008-04-23 |
| 1831369735 | Rajendra R Shroff Md Sc | Internal Medicine | 1050 M L King Dr Ste 101, Centralia, IL 62801-3060 | 2008-03-06 |
| 1417090044 | Romil Wadhawan | Internal Medicine | 1010 S Scheuber Rd, Suite 3&4, Centralia, WA 98531-8892 | 2007-02-14 |
| 1689714511 | Habibur Rahman | Internal Medicine | 2857, 161 East, Box 1233, Centralia, IL 62801-9118 | 2007-02-08 |
| 1699792242 | Guito Wingfield | Internal Medicine | 1707 Cooks Hill Rd, Centralia, WA 98531-9071 | 2006-07-17 |
| 1265467930 | Jong-wook Ban | Internal Medicine | 1010 S Scheuber Rd Ste 3&4, Centralia, WA 98531-8892 | 2006-07-11 |
| 1942260427 | Hari P Pathi | Internal Medicine | 914 S. Scheuber Road, Pmg Sw Wa PCh Hospitalists, Centralia, WA 98531 | 2006-03-27 |
| 1649267196 | Loren D Cooper | Internal Medicine | 1800 Cooks Hill Rd, Suite B, Centralia, WA 98531-9072 | 2005-09-30 |
| 1851392229 | James Louis Schutzenhofer | Internal Medicine | 1050 Martin Luther King Drive, Centralia, IL 62801 | 2005-08-09 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.