Provider Demographics
NPI:1528101193
Name:KOPEIKIN, BRIAN N (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:N
Last Name:KOPEIKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 NICHOLAS LN
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93108-1733
Mailing Address - Country:US
Mailing Address - Phone:805-455-4584
Mailing Address - Fax:805-966-4191
Practice Address - Street 1:22 NICHOLAS LN
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93108-1733
Practice Address - Country:US
Practice Address - Phone:805-455-4584
Practice Address - Fax:805-966-4191
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73649174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF36407Medicare UPIN