Provider Demographics
NPI:1841974862
Name:JEFFREY SHUKHMAN DO PC
Entity type:Organization
Organization Name:JEFFREY SHUKHMAN DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUKHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-650-1656
Mailing Address - Street 1:22554 VENTURA BLVD STE 129
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1469
Mailing Address - Country:US
Mailing Address - Phone:818-722-8952
Mailing Address - Fax:747-267-6342
Practice Address - Street 1:22554 VENTURA BLVD STE 129
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1469
Practice Address - Country:US
Practice Address - Phone:818-722-8952
Practice Address - Fax:747-267-6342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care