# LESLIE ALEX KONKIN, M.D., INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427061993
- **Authorized official:** LESLIE ALEX KONKIN M.D. (OWNER-PRESIDENT)
- **Authorized official phone:** (209) 571-5071

## Contact information

- **Practice address:** 1501 OAKDALE RD STE 301, MODESTO, CA 95355-3382
- **Practice address phone:** (209) 571-5071
- **Practice address fax:** (209) 577-1157
- **Mailing address:** PO BOX 576158, MODESTO, CA 95357-6158
- **Mailing address phone:** (209) 571-5071
- **Mailing address fax:** (209) 577-1157

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | G24534 | CA | Yes |

## Other

- **Enumeration date:** 08/14/2006
- **Last updated:** 10/17/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 9703018 | — | CA |
| 01 | — | ZZZ06639Z | GROUP PTAN | CA |