Provider Demographics
NPI:1528164126
Name:JOY, IKONIJA SEKULOVICH (MD)
Entity type:Individual
Prefix:DR
First Name:IKONIJA
Middle Name:SEKULOVICH
Last Name:JOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CONNIE
Other - Middle Name:SEKULOVICH
Other - Last Name:JOY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:920 E WARDLOW RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4630
Mailing Address - Country:US
Mailing Address - Phone:562-427-8944
Mailing Address - Fax:562-427-4086
Practice Address - Street 1:920 E WARDLOW RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4630
Practice Address - Country:US
Practice Address - Phone:562-427-8944
Practice Address - Fax:562-427-4086
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG253702086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC35952Medicare UPIN