Healthcare Provider Details

I. General information

NPI: 1801963996
Provider Name (Legal Business Name): ERVIN EPSTEIN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 30TH ST SUITE 205
OAKLAND CA
94609-3306
US

IV. Provider business mailing address

400 - 30TH STREET SUITE 205
OAKLAND CA
94609-3305
US

V. Phone/Fax

Practice location:
  • Phone: 510-444-8282
  • Fax: 510-444-8284
Mailing address:
  • Phone: 510-444-8282
  • Fax: 510-444-8284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA22751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: