Oleg Prokopenko, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT19551 Issued in CA

Practice address

360 S Oakhurst Dr
Beverly Hills, CA 90212

Phone

(310) 625-9768

NPI assigned

Jul 5, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572134400000",
    "number": "1629009246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 S OAKHURST DR",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902123506",
            "telephone_number": "310-625-9768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 S OAKHURST DR",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "90212",
            "telephone_number": "310-625-9768"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "948 N Fairfax Ave",
            "address_2": "Suite 201",
            "address_purpose": "LOCATION",
            "city": "West Hollywood",
            "state": "CA",
            "postal_code": "900467204",
            "country_code": "US",
            "telephone_number": "323-656-1960",
            "fax_number": "323-656-1921",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROKOPENKO",
        "first_name": "OLEG",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2019-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT19551",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Beverly Hills, CA
• Providers in Beverly Hills, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.