MEDICARE: KOUROSH BEROUKHIM 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	207ND0101X	MOHS-Micrographic Surgery Physician	A152655	CA
2	207N00000X	Dermatology Physician	A152655	CA

General Provider Information

NPI Number	:	1063866150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KOUROSH BEROUKHIM M.D.

Provider Business Mailing Address
First Line	:	3828 SCHAUFELE AVE STE 300
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-1793
Country	:	US
Telephone Number	:	562-997-1144
Fax Number	:	562-997-9881

Provider Business Practice Location Address
First Line	:	3828 SCHAUFELE AVE STE 300
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-1793
Country	:	US
Telephone Number	:	562-997-1144
Fax Number	:	562-997-9881

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

Provider Enumeration Date	:	04/15/2016
Last Update Date	:	01/05/2026

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