Provider Demographics
NPI:1114763612
Name:BOKA, BAILEY JENE (PA-C)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:JENE
Last Name:BOKA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 W TEMPLE ST STE 4691
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-7336
Mailing Address - Country:US
Mailing Address - Phone:213-238-5887
Mailing Address - Fax:213-444-7212
Practice Address - Street 1:1711 W TEMPLE ST STE 4675
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-7336
Practice Address - Country:US
Practice Address - Phone:213-238-5887
Practice Address - Fax:213-444-7212
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA66349363A00000X
NC0010-14456363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty