Provider Demographics
NPI:1912083924
Name:ABRAHIM, SHOKOOR (PA)
Entity Type:Individual
Prefix:
First Name:SHOKOOR
Middle Name:
Last Name:ABRAHIM
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 BRIDGEGATE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1466
Mailing Address - Country:US
Mailing Address - Phone:805-497-7811
Mailing Address - Fax:818-879-0401
Practice Address - Street 1:3484 E. FIRST ST.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90063-2946
Practice Address - Country:US
Practice Address - Phone:323-268-4436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13963363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS83022Medicare UPIN
CAWPA13963BMedicare ID - Type Unspecified