MEDICARE: SOKYAHEALTH MEDICAL GROUP PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	103T00000X	Psychologist
3	1041C0700X	Clinical Social Worker
4	106H00000X	Marriage & Family Therapist
5	2084P0800X	Psychiatry Physician
6	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
7	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1447842232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOKYAHEALTH MEDICAL GROUP PC

Provider Business Mailing Address
First Line	:	PO BOX 601422
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92160-1422
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 S MACADAM AVE STE 230
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3927
Country	:	US
Telephone Number	:	866-657-6592
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF CRED
Name	:	JOANNA CASTANEDA
Credential	:
Telephone Number	:	866-657-6592

Provider Enumeration Date	:	02/03/2021
Last Update Date	:	04/02/2025

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