Provider Demographics
NPI:1619918943
Name:BOKHARI, SYED W (M D)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:W
Last Name:BOKHARI
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3681 SUNNYSIDE DR UNIT 2278
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92516-4013
Mailing Address - Country:US
Mailing Address - Phone:951-682-6900
Mailing Address - Fax:951-682-6905
Practice Address - Street 1:4646 BROCKTON AVE STE 301
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-0103
Practice Address - Country:US
Practice Address - Phone:951-682-6900
Practice Address - Fax:951-682-6905
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69346207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A693460Medicaid
00A693461Medicare ID - Type Unspecified
CA00A693460Medicaid
H30139Medicare UPIN