Healthcare Provider Details

I. General information

NPI: 1326128455
Provider Name (Legal Business Name): BARUCH D KUPPERMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 HEALTH SCIENCES RD
IRVINE CA
92617-3058
US

IV. Provider business mailing address

UCI OPHTHALMOLOGY GROUP PO BOX 51055
LOS ANGELES CA
90051-5355
US

V. Phone/Fax

Practice location:
  • Phone: 949-824-2020
  • Fax:
Mailing address:
  • Phone: 714-456-6369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number000000G63254
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberG63254
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: