Provider Demographics
NPI:1366978918
Name:ZIKRY, JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:ZIKRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 WILSHIRE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5626
Mailing Address - Country:US
Mailing Address - Phone:310-829-0260
Mailing Address - Fax:310-829-0263
Practice Address - Street 1:1811 WILSHIRE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5626
Practice Address - Country:US
Practice Address - Phone:310-829-0260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2022-03-23
Deactivation Date:2018-06-11
Deactivation Code:
Reactivation Date:2018-06-27
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA159681207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program