Healthcare Provider Details

I. General information

NPI: 1457794067
Provider Name (Legal Business Name): MICHAEL BROUKHIM, M.D. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1762 WESTWOOD BLVD SUITE 300
LOS ANGELES CA
90024-5632
US

IV. Provider business mailing address

1762 WESTWOOD BLVD SUITE 300
LOS ANGELES CA
90024-5632
US

V. Phone/Fax

Practice location:
  • Phone: 310-441-2000
  • Fax:
Mailing address:
  • Phone: 310-441-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA101434
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberA101434
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA101434
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA101434
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA101434
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL BROUKHIM
Title or Position: CEO
Credential: M.D.
Phone: 310-441-2000