MEDICARE: BAILEY JENE BOKA PA-C

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	363A00000X	Physician Assistant	PA66349	CA
2	363A00000X	Physician Assistant	0010-14456	NC

General Provider Information

NPI Number	:	1114763612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAILEY JENE BOKA PA-C

Provider Business Mailing Address
First Line	:	1711 W TEMPLE ST STE 4691
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-7336
Country	:	US
Telephone Number	:	213-238-5887
Fax Number	:	213-444-7212

Provider Business Practice Location Address
First Line	:	1711 W TEMPLE ST STE 4675
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-7336
Country	:	US
Telephone Number	:	213-238-5887
Fax Number	:	213-444-7212

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

Provider Enumeration Date	:	07/03/2024
Last Update Date	:	07/11/2025

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