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General NPI Number Information
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NPI Number | 1063866150
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Entity Type | Individual
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Provider Name | KOUROSH BEROUKHIM M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/15/2016
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 3828 SCHAUFELE AVE STE 300
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City | LONG BEACH
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State | CA
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Zip | 90808-1793
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Country | US
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Telephone | 562-997-1144
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Fax | 562-997-9881
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Provider Business Mailing Address
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Address Line | 3828 SCHAUFELE AVE STE 300
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City | LONG BEACH
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State | CA
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Zip | 90808-1793
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Country | US
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Telephone | 562-997-1144
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Fax | 562-997-9881
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | A152655
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A152655
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License Number State | CA
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