Healthcare Provider Details

I. General information

NPI: 1619600939
Provider Name (Legal Business Name): MR. EHSAN DAVID KNOPF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 HOOD RD
BROOKLINE NH
03033-2439
US

IV. Provider business mailing address

40 HOOD RD
BROOKLINE NH
03033-2439
US

V. Phone/Fax

Practice location:
  • Phone: 213-705-0486
  • Fax:
Mailing address:
  • Phone: 213-705-0486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number126617
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: