Provider Demographics
NPI:1497758213
Name:BOSE, SHIKHA (MD)
Entity Type:Individual
Prefix:
First Name:SHIKHA
Middle Name:
Last Name:BOSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:31255 CEDAR VALLEY DR
Mailing Address - Street 2:STE 324
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-7129
Mailing Address - Country:US
Mailing Address - Phone:818-338-8103
Mailing Address - Fax:818-338-8119
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:RM 8725
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-423-6627
Practice Address - Fax:310-423-0170
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2015-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAWA65748C174400000X
CAA65768207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA65748CMedicare ID - Type Unspecified