Healthcare Provider Details

I. General information

NPI: 1619918943
Provider Name (Legal Business Name): SYED W BOKHARI M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 BROCKTON AVE STE 301
RIVERSIDE CA
92506-0103
US

IV. Provider business mailing address

3681 SUNNYSIDE DR UNIT 2278
RIVERSIDE CA
92516-4013
US

V. Phone/Fax

Practice location:
  • Phone: 951-682-6900
  • Fax: 951-682-6905
Mailing address:
  • Phone: 951-682-6900
  • Fax: 951-682-6905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA69346
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA69346
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: