Healthcare Provider Details

I. General information

NPI: 1962643528
Provider Name (Legal Business Name): LAWRENCE M. KOPLIN, MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2009
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 N ROXBURY DR STE. 802
BEVERLY HILLS CA
90210-4206
US

IV. Provider business mailing address

11999 SAN VICENTE BLVD #440
LOS ANGELES CA
90049-5131
US

V. Phone/Fax

Practice location:
  • Phone: 310-277-3223
  • Fax:
Mailing address:
  • Phone: 310-471-5852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE M. KOPLIN
Title or Position: OWNER
Credential: MD
Phone: 310-277-3223