MEDICARE: PAUL BRADLEY BOHN MD

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	2084P0800X	Psychiatry Physician	G56308	CA
2	2084P0802X	Addiction Psychiatry Physician	G56308	CA
3	2084F0202X	Forensic Psychiatry Physician	G56308	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00G563080	OTHER	CA	MEDI CAL

General Provider Information

NPI Number	:	1568488963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL BRADLEY BOHN MD

Provider Business Mailing Address
First Line	:	12300 WILSHIRE BLVD STE 330
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1057
Country	:	US
Telephone Number	:	310-829-1924
Fax Number	:

Provider Business Practice Location Address
First Line	:	12300 WILSHIRE BLVD STE 330
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1057
Country	:	US
Telephone Number	:	310-829-1924
Fax Number	:

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

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	09/11/2025

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