Provider Demographics
NPI:1558823393
Name:CARTER, KEVIN KOPALA (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:KOPALA
Last Name:CARTER
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 1:204 S RAMPART BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-1404
Mailing Address - Country:US
Mailing Address - Phone:720-935-3776
Mailing Address - Fax:
Practice Address - Street 1:723 HOPKINS AVE UNIT B
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1222
Practice Address - Country:US
Practice Address - Phone:720-935-3776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1774972085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology