Provider Demographics
NPI:1609544535
Name:AKHNOUKH, SIMON
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:
Last Name:AKHNOUKH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 E 3RD ST APT 1401
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-2674
Mailing Address - Country:US
Mailing Address - Phone:727-481-8149
Mailing Address - Fax:
Practice Address - Street 1:950 E 3RD ST APT 1401
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-2674
Practice Address - Country:US
Practice Address - Phone:727-481-8149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA200843208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery