Provider Demographics
NPI:1568488963
Name:BOHN, PAUL BRADLEY (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:BRADLEY
Last Name:BOHN
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 1:12300 WILSHIRE BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1057
Mailing Address - Country:US
Mailing Address - Phone:310-829-1924
Mailing Address - Fax:
Practice Address - Street 1:12300 WILSHIRE BLVD STE 330
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1057
Practice Address - Country:US
Practice Address - Phone:310-829-1924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG563082084P0800X, 2084P0802X, 2084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Not Answered2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G563080OtherMEDI CAL
CAE02793Medicare UPIN
CA00G563080OtherMEDI CAL