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General NPI Number Information
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NPI Number | 1205281557
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Entity Type | Individual
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Provider Name | MICHAEL JACOB BROUKHIM D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/24/2016
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 14724 VENTURA BLVD STE 809
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-3508
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Country | US
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Telephone | 747-271-2701
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Fax | 310-693-5384
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Provider Business Mailing Address
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Address Line | 1927 HARBOR BLVD # 305
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City | COSTA MESA
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State | CA
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Zip | 92627-7600
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Country | US
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Telephone | 818-233-0155
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 20A17706
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License Number State | CA
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