Provider Demographics
NPI:1669618559
Name:PEYTON P. BEROOKIM, MD INC
Entity type:Organization
Organization Name:PEYTON P. BEROOKIM, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEYTON
Authorized Official - Middle Name:
Authorized Official - Last Name:BEROOKIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-271-1122
Mailing Address - Street 1:PO BOX 67672
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-0065
Mailing Address - Country:US
Mailing Address - Phone:310-273-7365
Mailing Address - Fax:310-273-7366
Practice Address - Street 1:150 N ROBERTSON BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211
Practice Address - Country:US
Practice Address - Phone:310-271-1122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91789207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty