MEDICARE: DR. KIMBERLY ELIZABETH IDOKO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	35.148856	OH
2	2084N0400X	Neurology Physician	U9973	TX
3	2084N0400X	Neurology Physician	73600	WI
4	2084N0400X	Neurology Physician	E-16293	AR
5	2084N0400X	Neurology Physician	MD61493501	WA
6	2084N0400X	Neurology Physician	255780	NY
7	2084N0400X	Neurology Physician	2023-02584	NC
8	2084N0400X	Neurology Physician	24757	NH
9	2084N0400X	Neurology Physician	35386	NE
10	2084N0400X	Neurology Physician	4301510507	MI
11	2084N0400X	Neurology Physician	04-43896	KS
12	2084N0400X	Neurology Physician	036152650	IL
13	2084N0400X	Neurology Physician	MD-50869	IA
14	2084N0400X	Neurology Physician	A-118232	CA

General Provider Information

NPI Number	:	1003080896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY ELIZABETH IDOKO M.D.

Provider Business Mailing Address
First Line	:	2801 OCEAN PARK BLVD # 2216
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-2905
Country	:	US
Telephone Number	:	888-618-5288
Fax Number	:	888-618-5288

Provider Business Practice Location Address
First Line	:	1401 LAVACA ST # 322
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-1634
Country	:	US
Telephone Number	:	888-618-5288
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2008
Last Update Date	:	07/03/2025

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