=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578639001
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | M S CHERKAS MD MED CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2006
-----------------------------------------------------
Last Update Date | 08/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12304 SANTA MONICA BLVD S 300
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-826-5622
-----------------------------------------------------
Fax | 310-207-0093
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12304 SANTA MONICA BLVD S 300
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-826-5622
-----------------------------------------------------
Fax | 310-207-0093
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MARSHALL S CHERKAS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 310-826-5622
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | G6206
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------