Provider Demographics
NPI:1184611816
Name:ATKINSON, HENRI C (MD)
Entity type:Individual
Prefix:DR
First Name:HENRI
Middle Name:C
Last Name:ATKINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8420 S 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-1333
Mailing Address - Country:US
Mailing Address - Phone:323-778-2642
Mailing Address - Fax:323-778-0301
Practice Address - Street 1:8420 S 8TH AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-1333
Practice Address - Country:US
Practice Address - Phone:323-778-2642
Practice Address - Fax:323-778-0301
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48088207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G480880Medicaid
CAG48088Medicare ID - Type Unspecified
CAA92786Medicare UPIN