Healthcare Provider Details

I. General information

NPI: 1982893012
Provider Name (Legal Business Name): MORSE K UPSHAW DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 S FREMONT AVE
ALHAMBRA CA
91803-4315
US

IV. Provider business mailing address

2142 S FREMONT AVE
ALHAMBRA CA
91803-4315
US

V. Phone/Fax

Practice location:
  • Phone: 626-289-1080
  • Fax: 626-289-1204
Mailing address:
  • Phone: 626-289-1080
  • Fax: 626-289-1204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberE2383
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberE2383
License Number StateCA

VIII. Authorized Official

Name: DR. MORSE KILBURN UPSHAW
Title or Position: CORP. PRESIDENT/PODIATRIST
Credential: D.P.M.
Phone: 626-289-1080