Healthcare Provider Details

I. General information

NPI: 1568488963
Provider Name (Legal Business Name): PAUL BRADLEY BOHN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12300 WILSHIRE BLVD STE 330
LOS ANGELES CA
90025-1057
US

IV. Provider business mailing address

12300 WILSHIRE BLVD STE 330
LOS ANGELES CA
90025-1057
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-1924
  • Fax:
Mailing address:
  • Phone: 310-829-1924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG56308
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberG56308
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberG56308
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: