Healthcare Provider Details

I. General information

NPI: 1164549655
Provider Name (Legal Business Name): GERSHON HEPNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 S WESTERN AVE
LOS ANGELES CA
90005-3112
US

IV. Provider business mailing address

722 S WESTERN AVE
LOS ANGELES CA
90005-3112
US

V. Phone/Fax

Practice location:
  • Phone: 213-383-7474
  • Fax:
Mailing address:
  • Phone: 213-383-7474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA30885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: