Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | A76392 | CA |
Y | 2084N0400X | Neurologist | A76392 | CA |
NPI | 1053365270 |
---|---|
Provider Name | Yuriy Verpukhovskiy |
First Address | Panorama City, CA 91402-4665 |
Second Address | Panorama City, CA 91402-4665 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 28/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A763920 | (05) | CA |
202824485 | TAX ID (01) | CA |
A76392 | LICENSE (01) | AR |
I31175 | (02) | CA |