=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831601996
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. SEENA KETAN CHOKSHI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2017
-----------------------------------------------------
Last Update Date | 06/11/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4211 AVALON BLVD APT 351
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90011-5622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-802-0323
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23121 BENT OAK RD
-----------------------------------------------------
City | DIAMOND BAR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91765-3014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P1300X
-----------------------------------------------------
Taxonomy Name | Psychiatric Pharmacist
-----------------------------------------------------
License Number | 77820
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 77820
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------