Healthcare Provider Details

I. General information

NPI: 1639346364
Provider Name (Legal Business Name): SOUTH SOUND INPATIENT PHYSICIANS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 S SCHEUBER RD
CENTRALIA WA
98531-9027
US

IV. Provider business mailing address

PO BOX 60000 FILE 31045
SAN FRANCISCO CA
94160-0001
US

V. Phone/Fax

Practice location:
  • Phone: 360-736-2803
  • Fax:
Mailing address:
  • Phone: 206-529-9724
  • 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: COO
Credential: COO
Phone: 253-682-1710