Healthcare Provider Details

I. General information

NPI: 1285890319
Provider Name (Legal Business Name): SOUND INPATIENT PHYSICIANS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MISSION BLVD
JACKSON CA
95642-2564
US

IV. Provider business mailing address

FILE 30754 PO BOX 60000
SAN FRANCISCO CA
94160
US

V. Phone/Fax

Practice location:
  • Phone: 209-223-7500
  • Fax:
Mailing address:
  • Phone: 253-682-1710
  • 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