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General NPI Number Information
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NPI Number | 1225322019
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Entity Type | Individual
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Provider Name | KEVIN COPPELSON D.D.S., M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/08/2011
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Last Update Date | 10/31/2019
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Provider Practice Location Address
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Address Line | 10921 WILSHIRE BLVD STE 912
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City | LOS ANGELES
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State | CA
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Zip | 90024
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Country | US
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Telephone | 310-579-9710
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Fax |
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Provider Business Mailing Address
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Address Line | 10921 WILSHIRE BLVD STE 912
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City | LOS ANGELES
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State | CA
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Zip | 90024-3906
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Country | US
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Telephone | 310-579-9710
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 34607
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 157675
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 34607
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 101077
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License Number State | CA
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