Healthcare Provider Details

I. General information

NPI: 1548255888
Provider Name (Legal Business Name): CATHERINE SOOK SONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 FLORIDA AVE
MODESTO CA
95350-4408
US

IV. Provider business mailing address

1500 FLORIDA AVE
MODESTO CA
95350-4408
US

V. Phone/Fax

Practice location:
  • Phone: 209-574-1365
  • Fax: 209-574-1372
Mailing address:
  • Phone: 209-543-7400
  • Fax: 209-543-7403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA71560
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: