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General NPI Number Information
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NPI Number | 1154698447
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Entity Type | Organization
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Legal Business Name | SHASHI .T SOOD M.D., INC
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Dates
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Enumeration Date | 11/30/2011
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Last Update Date | 02/02/2012
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Provider Practice Location Address
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Address Line | 1401 SPANOS CT STE 110
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City | MODESTO
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State | CA
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Zip | 95355-2812
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Country | US
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Telephone | 209-525-3185
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 SPANOS CT STE 110
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City | MODESTO
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State | CA
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Zip | 95355-2812
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Country | US
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Telephone | 209-525-3185
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Fax |
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Authorized Official
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Title or Position | M.D
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Name | DR. SHASHI TANEJA SOOD
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Credential | M.D
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Telephone | 209-525-3185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A38105
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License Number State | CA
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