=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619191517
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEFFREY A. BERMAN MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2007
-----------------------------------------------------
Last Update Date | 08/14/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2080 CENTURY PARK EAST # 305
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-553-5633
-----------------------------------------------------
Fax | 310-553-2469
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2080 CENTURY PARK EAST # 305
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-553-5633
-----------------------------------------------------
Fax | 310-553-2469
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MGR
-----------------------------------------------------
Name | MS. HELENE Y. HANADA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-553-5633
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | G42512
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------