Healthcare Provider Details

I. General information

NPI: 1407107196
Provider Name (Legal Business Name): MADELAINE CLAIR KUIPER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2012
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2336 SANTA MONICA BLVD STE 304
SANTA MONICA CA
90404-2067
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-998-4747
  • Fax:
Mailing address:
  • Phone: 310-301-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number20500
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: