Provider Demographics
NPI:1235229006
Name:SOKITCH, SHIROKO LILES (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIROKO
Middle Name:LILES
Last Name:SOKITCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VIVIAN
Other - Middle Name:V
Other - Last Name:SOKITCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3471 REGIONAL PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-8269
Mailing Address - Country:US
Mailing Address - Phone:707-524-9640
Mailing Address - Fax:707-524-9649
Practice Address - Street 1:3471 REGIONAL PKWY STE D
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-8269
Practice Address - Country:US
Practice Address - Phone:707-524-9640
Practice Address - Fax:707-524-9649
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG071078208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG071078OtherCA LICENSE
CA00G710780Medicare ID - Type UnspecifiedCA MEDICARE ID
CAG071078OtherCA LICENSE