Provider Demographics
NPI:1326244427
Name:YURIY VERPUKHOVSKIY MD INC
Entity Type:Organization
Organization Name:YURIY VERPUKHOVSKIY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YURIY
Authorized Official - Middle Name:
Authorized Official - Last Name:VERPUKHOVSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-904-9200
Mailing Address - Street 1:14860 ROSCOE BLVD
Mailing Address - Street 2:STE 306
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4665
Mailing Address - Country:US
Mailing Address - Phone:818-904-9200
Mailing Address - Fax:818-904-9300
Practice Address - Street 1:14860 ROSCOE BLVD
Practice Address - Street 2:STE 306
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4665
Practice Address - Country:US
Practice Address - Phone:818-904-9200
Practice Address - Fax:818-904-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76392261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA76392OtherLICENSE
CA00A763920Medicaid
CA00A763920Medicaid
CA=========OtherEIN
CAW21249Medicare PIN