NPIMap

Organization Active NPI

Serge Obukhov, M.D. PC

  • Neurological Surgery Physician
  • Garden Grove, CA
National Provider Identifier
1386968543
Registry record updated Mar 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
A65490 Issued in CA
Legal business name
SERGE OBUKHOV, M.D. PC
Practice address
13252 Garden Grove Blvd
Suite 112
Garden Grove, CA 92843-2204
Phone
(714) 740-1778
Fax
(714) 740-1913
NPI assigned
Mar 17, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Serge Obukhoff, MDNPI 1295882496
Title
Owner
Phone
(714) 740-1778

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207T00000X A65490 CA Primary

Addresses

Primary practice location

13252 Garden Grove Blvd
Suite 112
Garden Grove, CA 92843-2204

Mailing address

27159 Sea Vista Dr
Malibu, CA 90265-4436
Phone (714) 740-1778

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268784000000",
    "number": "1386968543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27159 SEA VISTA DR",
            "city": "MALIBU",
            "state": "CA",
            "postal_code": "902654436",
            "telephone_number": "714-740-1778",
            "fax_number": "714-740-1913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13252 GARDEN GROVE BLVD",
            "address_2": "SUITE 112",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928432204",
            "telephone_number": "714-740-1778",
            "fax_number": "714-740-1913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERGE OBUKHOV, M.D. PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-17",
        "last_updated": "2010-03-17",
        "status": "A",
        "authorized_official_last_name": "OBUKHOFF",
        "authorized_official_first_name": "SERGE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-740-1778",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": "CA",
            "license": "A65490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden Grove, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.