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General NPI Number Information
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NPI Number | 1124066436
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Entity Type | Individual
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Provider Name | THOMAS E CONKLIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 02/11/2015
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Provider Practice Location Address
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Address Line | 18417 NORDHOFF ST SUITE# B
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City | NORTHRIDGE
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State | CA
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Zip | 91325-2200
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Country | US
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Telephone | 818-701-0551
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Fax | 818-701-5360
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Provider Business Mailing Address
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Address Line | 2650 SANTA YNEZ AVE
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City | SIMI VALLEY
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State | CA
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Zip | 93063-2387
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Country | US
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Telephone | 818-701-0551
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Fax | 818-701-5360
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 156153
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License Number State | MA
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