Basic Information
| Provider Information | |||||||||
| NPI: | 1396016838 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SON | ||||||||
| FirstName: | CHANG O | ||||||||
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| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 48 NEW MARKET SQUARE | ||||||||
| Address2: | JENCARE NEIGHBORHOOD MEDICAL NEW MARKET, LLC | ||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578258030 | ||||||||
| FaxNumber: | 7572449003 | ||||||||
| Practice Location | |||||||||
| Address1: | 48 NEW MARKET SQUARE | ||||||||
| Address2: | JENCARE NEIGHBORHOOD MEDICAL NEW MARKET, LLC | ||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578258030 | ||||||||
| FaxNumber: | 7572449003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2012 | ||||||||
| LastUpdateDate: | 08/18/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101255714 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.