Organization
LESLIE ALEX KONKIN, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE ALEX KONKIN M.D. (OWNER-PRESIDENT)
(209) 571-5071
Entity
Organization
Contact information
Practice address
1501 OAKDALE RD STE 301, MODESTO, CA 95355-3382
(209) 571-5071
(209) 577-1157
Mailing address
PO BOX 576158, MODESTO, CA 95357-6158
(209) 571-5071
(209) 577-1157
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
G24534
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9703018
—
CA
01
—
ZZZ06639Z
GROUP PTAN
CA
Enumeration date
08/14/2006
Last updated
10/17/2014
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