Healthcare Provider Details

I. General information

NPI: 1154563799
Provider Name (Legal Business Name): SUKHJIT SAMRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2009
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 SCENIC DR
MODESTO CA
95350-6137
US

IV. Provider business mailing address

1224 SCENIC DR
MODESTO CA
95350-6137
US

V. Phone/Fax

Practice location:
  • Phone: 800-380-9366
  • Fax: 833-573-2336
Mailing address:
  • Phone: 800-380-9366
  • Fax: 833-573-2336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA108999
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: