Provider Demographics
NPI:1689024887
Name:KEITH G TOKUHARA MD INC
Entity Type:Organization
Organization Name:KEITH G TOKUHARA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOKUHARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-340-4700
Mailing Address - Street 1:35900 BOB HOPE DR STE 175
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1767
Mailing Address - Country:US
Mailing Address - Phone:760-340-4700
Mailing Address - Fax:760-568-2490
Practice Address - Street 1:35900 BOB HOPE DR STE 175
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1767
Practice Address - Country:US
Practice Address - Phone:760-340-4700
Practice Address - Fax:760-568-2490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-17
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97863261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1386822641Medicare Oscar/Certification