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General NPI Number Information
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NPI Number | 1962659151
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Entity Type | Organization
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Legal Business Name | BENJAMIN BROUKHIM M.D. A MEDICAL CORP
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Dates
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Enumeration Date | 08/19/2008
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Last Update Date | 08/29/2014
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Provider Practice Location Address
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Address Line | 11650 RIVERSIDE DR SECOND FLOOR
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91602-1093
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Country | US
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Telephone | 818-755-6070
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Fax | 818-755-1870
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Provider Business Mailing Address
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Address Line | 11650 RIVERSIDE DR SECOND FLOOR
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91602-1093
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Country | US
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Telephone | 818-755-6070
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Fax | 818-755-1870
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. BENJAMIN BROUKHIM
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Credential | M.D.
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Telephone | 818-755-6070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A37198
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License Number State | CA
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