Provider Demographics
NPI:1205281557
Name:BROUKHIM, MICHAEL JACOB (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JACOB
Last Name:BROUKHIM
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1927 HARBOR BLVD # 305
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-7600
Mailing Address - Country:US
Mailing Address - Phone:818-233-0155
Mailing Address - Fax:
Practice Address - Street 1:14724 VENTURA BLVD STE 809
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3508
Practice Address - Country:US
Practice Address - Phone:747-271-2701
Practice Address - Fax:310-693-5384
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-24
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A177062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry