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DR. CHANG KI SONG MD
NPI 1609892728
Surgery in Peoria, IL

Active since July 14, 2006
5401 N KNOXVILLE AVE, SUITE 217, PEORIA, IL 61614(309) 691-1092(309) 689-6092 Get Directions Write a Review

NPPES record last updated: December 5, 2008. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Dr. Chang Ki Song Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. CHANG KI SONG MD (NPI 1609892728) is an individual surgery provider in Peoria, Illinois, licensed in Illinois (036060265) and active in the NPI registry since July 2006.

NPPES Registry Identity

NPI1609892728
Entity TypeIndividualMale
Primary Taxonomy208600000X
Provider Legal NameDR. CHANG KI SONGCredential: MD
Location Address5401 N KNOXVILLE AVE, SUITE 217Peoria, IL 61614-5098
Mailing Address5401 N Knoxville Ave, Suite 209Peoria, IL 61614-5098 · (309) 691-1092 · Fax (309) 689-6092
Phone(309) 691-1092
Fax(309) 689-6092
Sole ProprietorYes
Enumeration DateJuly 14, 2006
Last NPPES UpdateDecember 5, 2008
✔ NPI 1609892728 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySurgeryAllopathic & Osteopathic Physicians
Taxonomy Code208600000X
License✔ Licensed in IL · 036060265
Definition
A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.
Also ListedSurgery · Vascular SurgeryTaxonomy 2086S0129X · License 036060265 (IL)
5401 N KNOXVILLE AVE, Peoria, IL 61614
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Other Names 1

Other Name (5)Dr. C K Song Md

Other Identifiers 5

Other07221997IL · Blue Cross Blue Shield
Medicare UPINC03578
Other371366500Ein
Medicaid036060265IL
Medicare ID-Type Unspecified399880

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

YIBING LI MD
Physical Medicine & Rehabilitation
5401 N KNOXVILLE AVE, STE 117
PEORIA, IL 61614
Peoria County (309) 689-8888
PATTI L ALLY
Audiologist-Hearing Aid Fitter
5401 N KNOXVILLE AVE, SUITE 116
PEORIA, IL 61614
Peoria County (309) 282-0887
PROCTOR HEALTH SYSTEMS
Clinic/Center (Medical Specialty)
5401 N KNOXVILLE AVE, SUITE 103
PEORIA, IL 61614
Peoria County (309) 691-7800
MS. BARBARA J NALL APN
Nurse Practitioner (Women's Health)
5401 N KNOXVILLE AVE, SUITE 308
PEORIA, IL 61614
Peoria County (309) 692-5100
SUSAN GWILLIM PT
Physical Therapist
5401 N KNOXVILLE AVE, SUITE 218
PEORIA, IL 61614
Peoria County (309) 693-2244
MR. KEVIN M HENRY MD
Anesthesiology (Pain Medicine)
5401 N KNOXVILLE AVE, SUITE 416
PEORIA, IL 61614
Peoria County (309) 692-7246
MS. COLLEEN SUSANNE CUSHING RAGON APN, CNS
Nurse Practitioner (Family)
5401 N KNOXVILLE AVE
PEORIA, IL 61614
Peoria County (309) 691-1069
SUSAN J COLE, MD & ASSOCIATES
Clinic/Center (Medical Specialty)
5401 N KNOXVILLE AVE, SUITE 107
PEORIA, IL 61614
Peoria County (309) 691-2311

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Chang Song's NPI number?

The NPI number for Chang Song is 1609892728. It was assigned to this individual provider in the NPPES registry on July 14, 2006. The provider is also known as Dr. C K Song MD.

Where is Chang Song located?

Chang Song practices at 5401 N Knoxville Ave Suite 217, Peoria, IL 61614. The listed phone number is (309) 691-1092.

What is Chang Song's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

When was this NPI record last updated?

The NPPES record for Chang Song was last updated on December 5, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.