Healthcare Provider Details

I. General information

NPI: 1063467033
Provider Name (Legal Business Name): PETER K. SIEN, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 NELSON AVE
MODESTO CA
95350-5341
US

IV. Provider business mailing address

1316 NELSON AVE
MODESTO CA
95350-5341
US

V. Phone/Fax

Practice location:
  • Phone: 209-575-5870
  • Fax: 209-575-5872
Mailing address:
  • Phone: 209-575-5870
  • Fax: 209-575-5872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberG32267
License Number StateCA

VIII. Authorized Official

Name: DR. PETER K SIEN
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 209-575-5870