Organization
PROPRIUS HEALTH MEDICAL GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREI N DOKUKIN MD (PRESIDENT)
(917) 647-5031
Entity
Organization
Contact information
Practice address
3939 ATLANTIC AVE STE 223, LONG BEACH, CA 90807
(562) 583-9345
(949) 502-8887
Mailing address
3939 ATLANTIC AVE STE 223, LONG BEACH, CA 90807-3535
(562) 583-9345
(495) 028-8879
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
A110631
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D2048806
CLIA WAIVED CERTIFICATE
CA
01
—
43221
CA MEDICAL BOARD- FICTITIOUS NAME PERMIT
CA
01
—
BU21223680
CITY OF LONG BEACH BUSINESS LICENSE
CA
01
—
C3423023
SECRETARY OF STATE CORPORATION NUMBER
CA
01
—
CLR00343337
CA CLINICAL LAB REGISTRATION
CA
01
—
ZZZ70684Y
BLUE SHIELD OF CALIFORNIA GROUP PROVIDER NUMBER
CA
Enumeration date
07/10/2012
Last updated
08/28/2025
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