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Individual
LESLIE A. KONKIN
Active
Individual
LESLIE A. KONKIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
G24534
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G245341
INDIVIDUAL PTAN
CA
05
—
9703018
—
CA
Enumeration date
08/14/2006
Last updated
04/05/2020
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