Basic Information
| Provider Information | |||||||||
| NPI: | 1487636270 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOIKE | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | KENJI | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2230 STOCKTON BLVD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958171419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167347389 | ||||||||
| FaxNumber: | 9168751086 | ||||||||
| Practice Location | |||||||||
| Address1: | 4875 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958201500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168744247 | ||||||||
| FaxNumber: | 9168751086 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | G072180 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 00G721800 | 05 | CA | MEDICAID |