MEDICARE: MR. ISAAC VERBUKH 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	207L00000X	Anesthesiology Physician	G71967	CA

General Provider Information

NPI Number	:	1942382858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ISAAC VERBUKH M.D.

Provider Business Mailing Address
First Line	:	11999 SAN VICENTE BLVD
Second Line	:	#440
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-5131
Country	:	US
Telephone Number	:	310-471-5852
Fax Number	:	310-471-3958

Provider Business Practice Location Address
First Line	:	7901 SANTA MONICA BLVD
Second Line	:	#101
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5177
Country	:	US
Telephone Number	:	323-650-9920
Fax Number	:

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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