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General NPI Number Information
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NPI Number | 1265498836
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Entity Type | Individual
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Provider Name | SAMUEL L KIPPER M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/24/2006
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Last Update Date | 05/09/2014
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Provider Practice Location Address
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Address Line | 1100 N TUSTIN AVE SUITE A
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City | SANTA ANA
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State | CA
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Zip | 92705-3509
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Country | US
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Telephone | 714-835-6055
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Fax | 714-285-9084
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Provider Business Mailing Address
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Address Line | PO BOX 6279
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City | INDIANAPOLIS
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State | IN
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Zip | 46206-6279
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Country | US
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Telephone | 866-727-1072
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Fax | 800-508-4751
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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 | 2085N0904X
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Taxonomy Name | Nuclear Radiology Physician
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License Number | A34500
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License Number State | CA
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