Provider Demographics
NPI:1699092023
Name:L. IRI KUPFERWASSER MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:L. IRI KUPFERWASSER MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:IRI
Authorized Official - Last Name:KUPFERWASSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-210-3883
Mailing Address - Street 1:16119 VANOWEN ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4822
Mailing Address - Country:US
Mailing Address - Phone:818-904-6782
Mailing Address - Fax:818-904-5896
Practice Address - Street 1:16119 VANOWEN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4822
Practice Address - Country:US
Practice Address - Phone:818-904-6782
Practice Address - Fax:818-904-5896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-25
Last Update Date:2010-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83900207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty