Individual
ANDREI N DOKUKIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3939 ATLANTIC AVE STE 223, LONG BEACH, CA 90807-3535
(562) 633-1765
(949) 502-8887
Mailing address
1439 W CHAPMAN AVE # 46, ORANGE, CA 92868-2738
(562) 633-1765
(949) 502-8887
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
A110631
CA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
A110631
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12086268
CAQH PROVIDER NUMBER
CA
01
—
A110631
STATE MEDICAL BOARD LICENSE
CA
Enumeration date
08/13/2009
Last updated
03/24/2020
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