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General NPI Number Information
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NPI Number | 1225917735
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Entity Type | Organization
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Legal Business Name | ROOTS ADDICTION & PSYCHIATRY MEDICAL GROUP, PC
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Dates
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Enumeration Date | 08/28/2025
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 3939 ATLANTIC AVE STE 102
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City | LONG BEACH
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State | CA
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Zip | 90807-3535
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Country | US
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Telephone | 562-583-9345
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Fax | 949-502-8887
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Provider Business Mailing Address
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Address Line | 3939 ATLANTIC AVE STE 102
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City | LONG BEACH
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State | CA
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Zip | 90807-3535
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Country | US
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Telephone | 562-583-9345
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Fax | 949-502-8887
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Authorized Official
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Title or Position | MD/ CEO
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Name | DR. ANDREI DOKUKIN
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Credential | MD
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Telephone | 917-647-5031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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