Healthcare Provider Details

I. General information

NPI: 1962664441
Provider Name (Legal Business Name): SOUND INPATIENT PHYSICIANS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 B GALE WILSON BLVD
FAIRFIELD CA
94533-3552
US

IV. Provider business mailing address

PO BOX 60000 FILE 30754
SAN FRANCISCO CA
94160-0001
US

V. Phone/Fax

Practice location:
  • Phone: 707-429-3600
  • Fax:
Mailing address:
  • Phone: 253-682-6011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES KODJABABIAN
Title or Position: CHIEF OPERATING OFFICER
Credential: C.O.O.
Phone: 253-682-1710