Provider Demographics
NPI:1073573283
Name:BROUKHIM, BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:BROUKHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11650 RIVERSIDE DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-1066
Mailing Address - Country:US
Mailing Address - Phone:818-755-6070
Mailing Address - Fax:818-755-1870
Practice Address - Street 1:10614 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-2373
Practice Address - Country:US
Practice Address - Phone:818-755-6070
Practice Address - Fax:818-755-1870
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37198207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A371980Medicaid
CAW18252OtherMEDICARE ID#
CA00A371980Medicaid