MEDICARE: YURIY VERPUKHOVSKIY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician	A76392	CA
2	2084N0400X	Neurology Physician	A76392	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	A76392	OTHER	AR	LICENSE
3	202824485	OTHER	CA	TAX ID

General Provider Information

NPI Number	:	1053365270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YURIY VERPUKHOVSKIY M.D.

Provider Business Mailing Address
First Line	:	14860 ROSCOE BLVD
Second Line	:	STE.306
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-4665
Country	:	US
Telephone Number	:	818-904-9200
Fax Number	:	818-904-9300

Provider Business Practice Location Address
First Line	:	14860 ROSCOE BLVD
Second Line	:	STE.306
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-4665
Country	:	US
Telephone Number	:	818-904-9200
Fax Number	:	818-904-9300

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	03/28/2014

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Directions to “ YURIY VERPUKHOVSKIY M.D.” Practice Location

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