Healthcare Provider Details

I. General information

NPI: 1003722679
Provider Name (Legal Business Name): MAKSIM RYAN YUKHTMAN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30870 RUSSELL RANCH RD STE 330
WESTLAKE VILLAGE CA
91362-7372
US

IV. Provider business mailing address

14530 BENEFIT ST UNIT 305
SHERMAN OAKS CA
91403-3740
US

V. Phone/Fax

Practice location:
  • Phone: 818-901-6600
  • Fax:
Mailing address:
  • Phone: 818-512-5552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number310752
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: