Healthcare Provider Details

I. General information

NPI: 1932465978
Provider Name (Legal Business Name): JAN DAVID TEPPER, DPM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

984 W FOOTHILL BLVD SUITE B
UPLAND CA
91786-3700
US

IV. Provider business mailing address

984 W FOOTHILL BLVD STE C
UPLAND CA
91786-3700
US

V. Phone/Fax

Practice location:
  • Phone: 909-920-0884
  • Fax:
Mailing address:
  • Phone: 909-920-9810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DHAVAL I PATEL
Title or Position: OWNER
Credential:
Phone: 909-920-9810