Individual
THOMAS E CONKLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
18417 NORDHOFF ST, SUITE# B, NORTHRIDGE, CA 91325-2200
(818) 701-0551
(818) 701-5360
Mailing address
2650 SANTA YNEZ AVE, SIMI VALLEY, CA 93063-2387
(818) 701-0551
(818) 701-5360
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
156153
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G44486
LICENSE NUMBER
CA
Enumeration date
06/02/2006
Last updated
02/11/2015
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