Provider Demographics
NPI:1457674343
Name:ALLAN A. SHOOK,M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ALLAN A. SHOOK,M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:ABRAHAM
Authorized Official - Last Name:SHOOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-349-1262
Mailing Address - Street 1:18433 ROSCOE BLVD
Mailing Address - Street 2:STE. 202
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4108
Mailing Address - Country:US
Mailing Address - Phone:818-348-1262
Mailing Address - Fax:818-349-7529
Practice Address - Street 1:18433 ROSCOE BLVD
Practice Address - Street 2:STE. 202
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4108
Practice Address - Country:US
Practice Address - Phone:818-348-1262
Practice Address - Fax:818-349-7529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37176207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G371760Medicaid