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General NPI Number Information
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NPI Number | 1003804717
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Entity Type | Organization
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Legal Business Name | JOHN D. UPHOLD, MD, INC.
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Dates
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Enumeration Date | 10/07/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 309 W BEVERLY BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-4308
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Country | US
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Telephone | 818-340-9988
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Fax | 818-587-2493
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Provider Business Mailing Address
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Address Line | PO BOX 4419
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City | WOODLAND HILLS
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State | CA
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Zip | 91365-4419
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Country | US
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Telephone | 818-340-9988
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Fax | 818-587-2493
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN D UPHOLD
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Credential | MD
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Telephone | 818-340-9988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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