Healthcare Provider Details

I. General information

NPI: 1922230887
Provider Name (Legal Business Name): DONALD BRIAN CONKLING DVM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2009
Last Update Date: 08/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 MASSON AVE
SAN BRUNO CA
94066-3133
US

IV. Provider business mailing address

805 MASSON AVE
SAN BRUNO CA
94066-3133
US

V. Phone/Fax

Practice location:
  • Phone: 650-952-6454
  • Fax: 650-871-8185
Mailing address:
  • Phone: 650-952-6454
  • Fax: 650-871-8185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number5967
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: