MEDICARE: PAUL KONIKOFF MD INC

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	C39915	CA
2	207L00000X	Anesthesiology Physician	C39915	CA

General Provider Information

NPI Number	:	1164483160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL KONIKOFF MD INC

Provider Business Mailing Address
First Line	:	PO BOX 7001
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91357-7001
Country	:	US
Telephone Number	:	818-888-7815
Fax Number	:	818-715-1722

Provider Business Practice Location Address
First Line	:	16055 VENTURA BLVD
Second Line	:	STE.#120
City	:	ENCINO
State	:	CA
Zip	:	91436-2601
Country	:	US
Telephone Number	:	818-789-9988
Fax Number	:	818-715-1722

Authorized Official
Title or Position	:	DIRECT OWNER
Name	:	PAUL KONIKOFF
Credential	:	M.D.
Telephone Number	:	818-888-7815

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	09/06/2011

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Directions to “PAUL KONIKOFF MD INC ” Practice Location

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