Provider Demographics
NPI:1013337575
Name:BEROUKHIM, MINOO (DDS)
Entity Type:Individual
Prefix:
First Name:MINOO
Middle Name:
Last Name:BEROUKHIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11870 SANTA MONICA BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2281
Mailing Address - Country:US
Mailing Address - Phone:310-207-4900
Mailing Address - Fax:
Practice Address - Street 1:11870 SANTA MONICA BLVD STE 212
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2281
Practice Address - Country:US
Practice Address - Phone:310-207-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45823122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist