Provider Demographics
NPI:1003080896
Name:IDOKO, KIMBERLY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ELIZABETH
Last Name:IDOKO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:16350 VENTURA BLVD STE D323
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-5300
Mailing Address - Country:US
Mailing Address - Phone:888-618-5288
Mailing Address - Fax:888-618-5288
Practice Address - Street 1:16350 VENTURA BLVD STE D323
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-5300
Practice Address - Country:US
Practice Address - Phone:888-618-5288
Practice Address - Fax:888-618-5288
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA1182322084N0400X
WI736002084N0400X
ARE-162932084N0400X
WAMD614935012084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology