Provider Demographics
NPI:1548255888
Name:SONG, CATHERINE SOOK (MD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:SOOK
Last Name:SONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4408
Mailing Address - Country:US
Mailing Address - Phone:209-543-7400
Mailing Address - Fax:209-543-7403
Practice Address - Street 1:1500 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4408
Practice Address - Country:US
Practice Address - Phone:209-574-1365
Practice Address - Fax:209-574-1372
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71560207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A715600Medicaid
CA3613034OtherMEDI-CAL
CA3613034OtherMEDI-CAL