MEDICARE: DR. BENJAMIN BROUKHIM 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	207X00000X	Orthopaedic Surgery Physician	A37198	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	W18252	OTHER	CA	MEDICARE ID#

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

General Provider Information

NPI Number	:	1073573283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN BROUKHIM M.D.

Provider Business Mailing Address
First Line	:	11650 RIVERSIDE DR
Second Line	:	2ND FLOOR
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-1066
Country	:	US
Telephone Number	:	818-755-6070
Fax Number	:	818-755-1870

Provider Business Practice Location Address
First Line	:	10614 RIVERSIDE DR
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-2373
Country	:	US
Telephone Number	:	818-755-6070
Fax Number	:	818-755-1870

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	07/11/2016

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Directions to “ DR. BENJAMIN BROUKHIM M.D.” Practice Location

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