Healthcare Provider Details

I. General information

NPI: 1033047055
Provider Name (Legal Business Name): BRAIN HEALTH IPA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4319 SEPULVEDA BLVD
CULVER CITY CA
90230-4715
US

IV. Provider business mailing address

4319 SEPULVEDA BLVD
CULVER CITY CA
90230-4715
US

V. Phone/Fax

Practice location:
  • Phone: 877-515-8113
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: EHAB YACOUB
Title or Position: CEO
Credential: MD
Phone: 877-515-8113