Provider Demographics
NPI:1023189289
Name:MICHAEL D. BOROOKHIM, M.D., INC
Entity Type:Organization
Organization Name:MICHAEL D. BOROOKHIM, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOROOKHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-777-6667
Mailing Address - Street 1:9301 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 602
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5424
Mailing Address - Country:US
Mailing Address - Phone:310-288-0881
Mailing Address - Fax:
Practice Address - Street 1:9301 WILSHIRE BLVD
Practice Address - Street 2:SUITE 602
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5424
Practice Address - Country:US
Practice Address - Phone:310-288-0881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A687060Medicaid
CAW16779Medicare ID - Type Unspecified
CAWA68706BMedicare ID - Type Unspecified
CA00A687060Medicaid