Provider Demographics
NPI:1871235085
Name:KAMRAN BROUKHIM, MD, PC
Entity Type:Organization
Organization Name:KAMRAN BROUKHIM, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROUKHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-693-3655
Mailing Address - Street 1:19228 VENTURA BLVD UNIT D
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3101
Mailing Address - Country:US
Mailing Address - Phone:818-875-0750
Mailing Address - Fax:818-578-8616
Practice Address - Street 1:19228 VENTURA BLVD UNIT D
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3101
Practice Address - Country:US
Practice Address - Phone:818-875-0750
Practice Address - Fax:818-578-8616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty