MEDICARE: DR. VLADIMIR BOKARIUS M.D., PH.D., L.AC

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	2084P0800X	Psychiatry Physician	A84559	CA
2	2084P0805X	Geriatric Psychiatry Physician	A84559	CA
3	2084P2900X	Pain Medicine (Psychiatry & Neurology) Physician	A84559	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CK860A	OTHER	CA	PTAN

General Provider Information

NPI Number	:	1629021365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VLADIMIR BOKARIUS M.D., PH.D., L.AC

Provider Business Mailing Address
First Line	:	2970 HILLTOP MALL RD
Second Line	:	STE 101
City	:	RICHMOND
State	:	CA
Zip	:	94806-1948
Country	:	US
Telephone Number	:	510-323-2524
Fax Number	:	510-323-2524

Provider Business Practice Location Address
First Line	:	3260 BLUME DR STE 450
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94806-5203
Country	:	US
Telephone Number	:	415-787-4667
Fax Number	:	415-787-4667

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	12/30/2017

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