Provider Demographics
NPI:1609434364
Name:DAN BEROUKHIM DDS INC
Entity Type:Organization
Organization Name:DAN BEROUKHIM DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEROUKHIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-498-5682
Mailing Address - Street 1:2010 S BEVERLY GLEN BLVD UNIT 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5179
Mailing Address - Country:US
Mailing Address - Phone:310-498-5682
Mailing Address - Fax:
Practice Address - Street 1:5432 SEPULVEDA BLVD STE A
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-5512
Practice Address - Country:US
Practice Address - Phone:310-498-5682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental