Provider Demographics
NPI:1063467033
Name:PETER K. SIEN, MD, INC.
Entity Type:Organization
Organization Name:PETER K. SIEN, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:K
Authorized Official - Last Name:SIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-575-5870
Mailing Address - Street 1:1316 NELSON AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5341
Mailing Address - Country:US
Mailing Address - Phone:209-575-5870
Mailing Address - Fax:209-575-5872
Practice Address - Street 1:1316 NELSON AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5341
Practice Address - Country:US
Practice Address - Phone:209-575-5870
Practice Address - Fax:209-575-5872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG322672085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G322670Medicaid
ZZZ30092ZMedicare PIN
CAA45079Medicare UPIN
CA00G322673Medicare ID - Type Unspecified