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Provider Information for 1396119905

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DAN BEROUKHIM DDS

Gender: MALE

Individual NPI: 1396119905

Calendar   Last Updated:  2017-10-20
  Certification Date: 

Details

Name Value
NPI 1396119905
Enumeration Date 2015-11-19
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 2010 S BEVERLY GLEN BLVD UNIT 201
LOS ANGELES, CA 90025-5179
United States

Phone: 310-498-5682 | Fax:
View Map External Link
Primary Practice Address 5432 SEPULVEDA BLVD STE A
CULVER CITY, CA 90230-5512
United States

Phone: 310-498-5682 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Other METLIFE CA 474997382
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice CA 64635