Healthcare Provider Details

I. General information

NPI: 1265362974
Provider Name (Legal Business Name): PACIFIC SACRAMENTO SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 3RD AVE STE B
SACRAMENTO CA
95817-2808
US

IV. Provider business mailing address

3601 PACIFIC AVE
STOCKTON CA
95211-0110
US

V. Phone/Fax

Practice location:
  • Phone: 913-313-9812
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DENNIS SONG
Title or Position: MEDICAL DIRECTOR
Credential: MD, DDS
Phone: 415-929-6603