Healthcare Provider Details

I. General information

NPI: 1720768898
Provider Name (Legal Business Name): OKSANA LELYUKH KOSTYUKEVICH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11938 PARAMOUNT BLVD
DOWNEY CA
90242-2306
US

IV. Provider business mailing address

11938 PARAMOUNT BLVD
DOWNEY CA
90242-2306
US

V. Phone/Fax

Practice location:
  • Phone: 562-923-6060
  • Fax: 562-923-6601
Mailing address:
  • Phone: 562-923-6060
  • Fax: 562-923-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA63203
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: