Healthcare Provider Details

I. General information

NPI: 1669566147
Provider Name (Legal Business Name): SERGEY AKOPOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S BUENA VISTA ST 1 NORTH OUTPATIENT NEURO CLINIC
BURBANK CA
91505-4809
US

IV. Provider business mailing address

PO BOX 27206
LOS ANGELES CA
90027
US

V. Phone/Fax

Practice location:
  • Phone: 818-847-4622
  • Fax:
Mailing address:
  • Phone: 213-385-0675
  • Fax: 213-365-6429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA72794
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA72794
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: