Healthcare Provider Details

I. General information

NPI: 1245569367
Provider Name (Legal Business Name): IAN JAMES CONCEPCION M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2009
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SERENO DR DEPARTMENT OF HOSPITAL BASED SPECIALISTS (HBS)
VALLEJO CA
94589-2441
US

IV. Provider business mailing address

975 SERENO DR DEPARTMENT OF HOSPITAL BASED SPECIALISTS (HBS)
VALLEJO CA
94589-2441
US

V. Phone/Fax

Practice location:
  • Phone: 707-651-1000
  • Fax:
Mailing address:
  • Phone: 707-651-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA107683
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: