Organization
TCHAKA B SHEPHERD MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TCHAKA SHEPHERD MD (OWNER)
(310) 802-9735
Entity
Organization
Contact information
Practice address
3628 E IMPERIAL HWY, SUITE 401, LYNWOOD, CA 90262-2643
(424) 213-4290
Mailing address
PO BOX 1250, REDONDO BEACH, CA 90278-0250
Taxonomy
Speciality
Code
Description
License number
State
2086S0127X
Trauma Surgery Physician
Primary
A72326
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1124078670
PERSONAL NPI
CA
Enumeration date
07/09/2010
Last updated
12/14/2010
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