Provider Demographics
NPI:1568581478
Name:AMIR VOKSHOOR MD MED CORP A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:AMIR VOKSHOOR MD MED CORP A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:VOKSHOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-854-3800
Mailing Address - Street 1:122 SHELDON ST
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-3915
Mailing Address - Country:US
Mailing Address - Phone:310-322-4278
Mailing Address - Fax:
Practice Address - Street 1:13160 MINDANAO WAY
Practice Address - Street 2:SUITE #300
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6358
Practice Address - Country:US
Practice Address - Phone:310-574-0400
Practice Address - Fax:310-322-6660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78293207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherEIN
CA6654050001Medicare NSC
CAW21055Medicare PIN