Healthcare Provider Details

I. General information

NPI: 1659448173
Provider Name (Legal Business Name): SUNSHINE WOMENS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4213 DALE RD SUITE 1
MODESTO CA
95356-8505
US

IV. Provider business mailing address

4213 DALE RD SUITE 1
MODESTO CA
95356-8505
US

V. Phone/Fax

Practice location:
  • Phone: 209-543-7400
  • Fax: 209-543-7403
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: DR. CATHERINE SOOK SONG
Title or Position: CEO
Credential: MD
Phone: 209-543-7400