Provider Demographics
NPI:1659448173
Name:SUNSHINE WOMENS MEDICAL CENTER
Entity Type:Organization
Organization Name:SUNSHINE WOMENS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:SOOK
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-543-7400
Mailing Address - Street 1:4213 DALE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-8505
Mailing Address - Country:US
Mailing Address - Phone:209-543-7400
Mailing Address - Fax:209-543-7403
Practice Address - Street 1:4213 DALE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-8505
Practice Address - Country:US
Practice Address - Phone:209-543-7400
Practice Address - Fax:209-543-7403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71560207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A715600Medicaid
CA3613034Medicaid
CA00A715600OtherBLUESHIELD PROVIDER NUMBE
CA7442284OtherBLUECROSS PROVIDER NUMBER
CA00A715600OtherBLUESHIELD PROVIDER NUMBE
CA00A715600Medicaid