Healthcare Provider Details

I. General information

NPI: 1235366550
Provider Name (Legal Business Name): HOWARD S KAUFMAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2009
Last Update Date: 01/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CONGRESS ST SUITE 300
PASADENA CA
91105-3045
US

IV. Provider business mailing address

PO BOX 50487
PASADENA CA
91115-0487
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-5896
  • Fax: 626-397-5899
Mailing address:
  • Phone: 626-397-5896
  • Fax: 636-397-5899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberC50932
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC50932
License Number StateCA

VIII. Authorized Official

Name: HOWARD S KAUFMAN
Title or Position: OWNER
Credential: MD
Phone: 626-397-5896