Provider Demographics
NPI:1326206301
Name:DAWKINS, MANJU CHACKO (MD)
Entity type:Individual
Prefix:DR
First Name:MANJU
Middle Name:CHACKO
Last Name:DAWKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MANJU
Other - Middle Name:TRACY
Other - Last Name:CHACKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5971 VENICE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-1713
Mailing Address - Country:US
Mailing Address - Phone:323-857-4322
Mailing Address - Fax:
Practice Address - Street 1:5971 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-1713
Practice Address - Country:US
Practice Address - Phone:323-857-4322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246191-1207N00000X
CAA121539207N00000X
CAFD2807052207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology