Provider Demographics
NPI:1699790907
Name:KUPPER, DANIEL A (PHD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:KUPPER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 1/2 WESTWOOD BLVD
Mailing Address - Street 2:STE 2
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-8400
Mailing Address - Country:US
Mailing Address - Phone:310-441-5537
Mailing Address - Fax:310-470-0863
Practice Address - Street 1:1917 1/2 WESTWOOD BLVD
Practice Address - Street 2:STE 2
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-8400
Practice Address - Country:US
Practice Address - Phone:310-825-9989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14082103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY140820Medicaid
CAPSY140820Medicaid