Provider Demographics
NPI:1578711818
Name:BIJAN BROUKHIM, MD, INC
Entity Type:Organization
Organization Name:BIJAN BROUKHIM, MD, INC
Other - Org Name:WOMEN'S MEDICAL GROUP OF ENCINO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BIJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROUKHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-501-6775
Mailing Address - Street 1:16311 VENTURA BOULEVARD
Mailing Address - Street 2:SUITE 1080
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4352
Mailing Address - Country:US
Mailing Address - Phone:818-501-6775
Mailing Address - Fax:818-501-2723
Practice Address - Street 1:16311 VENTURA BLVD
Practice Address - Street 2:SUITE 1080
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4352
Practice Address - Country:US
Practice Address - Phone:818-501-6775
Practice Address - Fax:818-501-2723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty