Active NPI
Sepehr Broukhim, D.O.
- Psychiatry Physician
- Sherman Oaks, CA
National Provider Identifier
1174715965
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 20A9307
- Practice address
- 15233 Ventura Blvd
Ste 1108
Sherman Oaks, CA 91403 - Phone
- (818) 590-2646
- NPI assigned
- Aug 15, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 20A9307 | CA | Primary |
Addresses
Primary practice location
15233 Ventura Blvd
Ste 1108
Sherman Oaks, CA 91403
Mailing address
15233 Ventura Blvd
Ste 1108
Sherman Oaks, CA 91403
Phone (818) 590-2646
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 020A93070 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20A9307 | CA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313020800000",
"number": "1174715965",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15233 VENTURA BLVD",
"address_2": "STE 1108",
"city": "SHERMAN OAKS",
"state": "CA",
"postal_code": "91403",
"telephone_number": "818-590-2646"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15233 VENTURA BLVD",
"address_2": "STE 1108",
"city": "SHERMAN OAKS",
"state": "CA",
"postal_code": "91403",
"telephone_number": "818-590-2646"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROUKHIM",
"first_name": "SEPEHR",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-08-15",
"last_updated": "2011-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "20A9307",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "020A93070",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sherman Oaks, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.