Provider Demographics
NPI:1336215631
Name:ALAN S BOOKIN MD INC
Entity Type:Organization
Organization Name:ALAN S BOOKIN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOOKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-454-0457
Mailing Address - Street 1:910 VIA DE LA PAZ
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3538
Mailing Address - Country:US
Mailing Address - Phone:310-454-0457
Mailing Address - Fax:310-459-1014
Practice Address - Street 1:910 VIA DE LA PAZ
Practice Address - Street 2:SUITE 104
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3538
Practice Address - Country:US
Practice Address - Phone:310-454-0457
Practice Address - Fax:310-459-1014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC27530207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW21705Medicare PIN