MEDICARE: BORIS BERZON MD INC

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	261QR0200X	Radiology Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A70349	OTHER	CA	LICENSE

General Provider Information

NPI Number	:	1063695302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BORIS BERZON MD INC

Provider Business Mailing Address
First Line	:	3631 CRENSHAW BLVD
Second Line	:	STE 102 103
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-4869
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3631 CRENSHAW BLVD
Second Line	:	STE 102 103
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-4869
Country	:	US
Telephone Number	:	323-730-5600
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BORIS BERZON
Credential	:
Telephone Number	:	323-730-5600

Provider Enumeration Date	:	12/10/2007
Last Update Date	:	04/20/2008

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Directions to “BORIS BERZON MD INC ” Practice Location

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