Provider Demographics
NPI:1003080896
Name:IDOKO, KIMBERLY ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ELIZABETH
Last Name:IDOKO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2801 OCEAN PARK BLVD # 2216
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2905
Mailing Address - Country:US
Mailing Address - Phone:888-618-5288
Mailing Address - Fax:888-618-5288
Practice Address - Street 1:1401 LAVACA ST # 322
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1634
Practice Address - Country:US
Practice Address - Phone:888-618-5288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI736002084N0400X
OH35.1488562084N0400X
TXU99732084N0400X
ARE-162932084N0400X
WAMD614935012084N0400X
NY2557802084N0400X
NC2023-025842084N0400X
NH247572084N0400X
NE353862084N0400X
MI43015105072084N0400X
KS04-438962084N0400X
IL0361526502084N0400X
IAMD-508692084N0400X
CAA1182322084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology