Basic Information
| Provider Information | |||||||||
| NPI: | 1285890319 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUND INPATIENT PHYSICIANS MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | FILE 30754 PO BOX 60000 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2536821710 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 MISSION BLVD | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956422564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2092237500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2008 | ||||||||
| LastUpdateDate: | 06/02/2009 | ||||||||
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| AuthorizedOfficialLastName: | KODJABABIAN | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2536821710 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | C.O.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.