1962653808 NPI number — DR. ROKSANA SHOKOUH DC

Table of content: DR. ROKSANA SHOKOUH DC (NPI 1962653808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962653808 NPI number — DR. ROKSANA SHOKOUH DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHOKOUH
Provider First Name:
ROKSANA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962653808
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1530 N POINSETTIA PL APT 236
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90046-7915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-233-0504
Provider Business Mailing Address Fax Number:
323-233-0593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
231 W VERNON AVE STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90037-2778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-233-0504
Provider Business Practice Location Address Fax Number:
323-233-0593
Provider Enumeration Date:
10/09/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111NI0013X , with the licence number:  DC 23983 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)