Healthcare Provider Details

I. General information

NPI: 1851597991
Provider Name (Legal Business Name): STEVEN BARRY KUPFERMAN DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 05/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 W SUNSET BLVD 6TH FLOOR
LOS ANGELES CA
90027-5814
US

IV. Provider business mailing address

2080 CENTURY PARK E SUITE 610
LOS ANGELES CA
90067-2001
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-4676
  • Fax:
Mailing address:
  • Phone: 310-842-4811
  • Fax: 310-286-2177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA97977
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number50071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: