Provider Demographics
NPI:1053387886
Name:SHOOK, ALLAN ABRAHAM (MD)
Entity type:Individual
Prefix:MR
First Name:ALLAN
Middle Name:ABRAHAM
Last Name:SHOOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18433 ROSCOE BLVD
Mailing Address - Street 2:STE. 202
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4130
Mailing Address - Country:US
Mailing Address - Phone:818-349-1262
Mailing Address - Fax:818-349-7529
Practice Address - Street 1:18433 ROSCOE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4108
Practice Address - Country:US
Practice Address - Phone:818-349-1262
Practice Address - Fax:818-349-7529
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37176174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G371760Medicaid
CA00G371760Medicaid