Healthcare Provider Details

I. General information

NPI: 1619002698
Provider Name (Legal Business Name): LAWRENCE MARK KOPLIN M.D.,F.A.C.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 NORTH ROXBURY DRIVE SUITE 800
BEVERLY HILLS CA
90210-4211
US

IV. Provider business mailing address

465 NORTH ROXBURY DRIVE SUITE 800
BEVERLY HILLS CA
90210
US

V. Phone/Fax

Practice location:
  • Phone: 310-277-3223
  • Fax: 310-278-9138
Mailing address:
  • Phone: 310-277-3223
  • Fax: 310-278-9138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG035647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: