CHANG KI SONG MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036060265

License Status

NOT RENEWED

Business

First Name

CHANG KI

Last Name

SONG

Suffix

Business Name

CHANG KI SONG MD

Original Issue Date

04/18/1980

Effective Date

05/23/2011

Expiration Date

07/31/2014

City

PEORIA

State

Zip

61615

County

PEORIA

Ever Disciplined

LastModifiedDate

11/17/2014