MEDICARE: NIKI DEJBA MD

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	207Q00000X	Family Medicine Physician	192966	CA

General Provider Information

NPI Number	:	1659952620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKI DEJBA MD

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	702-579-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	1075 N WESTERN AVE STE 110
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-2307
Country	:	US
Telephone Number	:	213-861-8700
Fax Number	:	213-861-8790

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

Provider Enumeration Date	:	04/20/2021
Last Update Date	:	12/12/2025

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