Provider Demographics
NPI:1659921971
Name:MODERN CARE MEDICAL GROUP INC
Entity Type:Organization
Organization Name:MODERN CARE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:SUTYEE
Authorized Official - Last Name:SUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-589-0135
Mailing Address - Street 1:8811 GARVEY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-2461
Mailing Address - Country:US
Mailing Address - Phone:626-589-0135
Mailing Address - Fax:626-795-0779
Practice Address - Street 1:8811 GARVEY AVE STE 101
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-2461
Practice Address - Country:US
Practice Address - Phone:626-589-0135
Practice Address - Fax:626-795-0779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty