MEDICARE: ROCDOCS A PROFESSIONAL MEDICAL CORPORATION

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	174400000X	Specialist	A78281	CA
2	174400000X	Specialist	A65423	CA

General Provider Information

NPI Number	:	1942724778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCDOCS A PROFESSIONAL MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	1127 WILSHIRE BLVD STE 1000
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1127 WILSHIRE BLVD STE 1000
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4001
Country	:	US
Telephone Number	:	310-882-3884
Fax Number	:	562-318-3048

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DEREK TAN DEE
Credential	:	MD
Telephone Number	:	310-408-5345

Provider Enumeration Date	:	08/02/2017
Last Update Date	:	08/17/2017

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