Basic Information
| Provider Information | |||||||||
| NPI: | 1356428924 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOEK | ||||||||
| FirstName: | RALPH | ||||||||
| MiddleName: | JAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5767 W CENTURY BLVD STE 400 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900455631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103018771 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 26585 WEST AGOURA BLVD. | ||||||||
| Address2: | STE 330 | ||||||||
| City: | CALABASAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188761050 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 10/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | G058707 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.