Healthcare Provider Details

I. General information

NPI: 1477979656
Provider Name (Legal Business Name): SIMONA ALEXANDRA FIKHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 LAUREL CANYON BLVD
STUDIO CITY CA
91604-4921
US

IV. Provider business mailing address

3959 LAUREL CANYON BLVD
STUDIO CITY CA
91604-4921
US

V. Phone/Fax

Practice location:
  • Phone: 818-505-9300
  • Fax:
Mailing address:
  • Phone: 818-505-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number51462
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: