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NPI Code Detail

MEDICARE: JOHN D. UPHOLD, MD, INC.

MEDICARE: JOHN D. UPHOLD, MD, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003804717
Entity Type Code : Organization
Provider Name (Legal Business Name) : JOHN D. UPHOLD, MD, INC.
Provider Business Mailing Address
First Line : PO BOX 4419
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91365-4419
Country : US
Telephone Number : 818-340-9988
Fax Number : 818-587-2493
Provider Business Practice Location Address
First Line : 309 W BEVERLY BLVD
Second Line :
City : MONTEBELLO
State : CA
Zip : 90640-4308
Country : US
Telephone Number : 818-340-9988
Fax Number : 818-587-2493
Authorized Official
Title or Position : PRESIDENT
Name : DR. JOHN D UPHOLD
Credential : MD
Telephone Number : 818-340-9988
Provider Enumeration Date : 10/07/2005
Last Update Date : 08/22/2020

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Directions to “JOHN D. UPHOLD, MD, INC. ” Practice Location

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