Active NPI
Thomas Lee Shook, M.D.
- Specialist
- Los Angeles, CA
National Provider Identifier
1104810050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- G59793
- Practice address
- 1245 Wilshire Blvd
Ste 703
Los Angeles, CA 90017-4810 - Phone
- (213) 977-7422
- Fax
- (213) 250-8945
- NPI assigned
- Sep 7, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | G59793 | CA | Primary |
Addresses
Primary practice location
1245 Wilshire Blvd
Ste 703
Los Angeles, CA 90017-4810
Mailing address
1245 Wilshire Blvd
Ste 703
Los Angeles, CA 90017-4810
Phone (213) 977-7422
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G597930 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G59793 | CA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1194912000000",
"number": "1104810050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1245 WILSHIRE BLVD",
"address_2": "STE 703",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900174810",
"telephone_number": "213-977-7422",
"fax_number": "213-250-8945"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1245 WILSHIRE BLVD",
"address_2": "STE 703",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900174810",
"telephone_number": "213-977-7422",
"fax_number": "213-250-8945"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHOOK",
"first_name": "THOMAS",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-07",
"last_updated": "2007-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "G59793",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G597930",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.