Healthcare Provider Details

I. General information

NPI: 1679486914
Provider Name (Legal Business Name): PCH DENTAL GROUP AND ORTHODONTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 PACIFIC COAST HWY UNIT 101
TORRANCE CA
90505-5914
US

IV. Provider business mailing address

2342 CANYONBACK RD
LOS ANGELES CA
90049-6811
US

V. Phone/Fax

Practice location:
  • Phone: 310-666-3276
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JONATHAN BEROUKHIM
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 310-666-3276