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General NPI Number Information
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NPI Number | 1386764744
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Entity Type | Organization
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Legal Business Name | BIJAN BROUKHIM, MD, INC
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 16311 VENTURA BLVD SUITE 925
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City | ENCINO
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State | CA
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Zip | 91436-2124
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Country | US
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Telephone | 818-501-6775
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Fax |
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Provider Business Mailing Address
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Address Line | 16311 VENTURA BLVD SUITE 1080
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City | ENCINO
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State | CA
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Zip | 91436-2124
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Country | US
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Telephone | 818-501-6775
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | BIJAN BROUKHIM
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Credential | M.D.
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Telephone | 818-501-6775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | CLF315352
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License Number State | CA
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