Healthcare Provider Details

I. General information

NPI: 1811949860
Provider Name (Legal Business Name): MICHAEL KUPFER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 MEDICAL CENTER DR
WEST HILLS CA
91307-1902
US

IV. Provider business mailing address

PO BOX 190
SIMI VALLEY CA
93062-0190
US

V. Phone/Fax

Practice location:
  • Phone: 818-676-4100
  • Fax:
Mailing address:
  • Phone: 805-522-5940
  • Fax: 805-522-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC41450
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: