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General NPI Number Information
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NPI Number | 1932268075
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Entity Type | Organization
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Legal Business Name | STEPHEN L KUCHENBECKER M D INC A PROF CORP
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 07/28/2014
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Provider Practice Location Address
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Address Line | 2001 SANTA MONICA BLVD STE 685W
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City | SANTA MONICA
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State | CA
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Zip | 90404-2186
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Country | US
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Telephone | 310-829-9400
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Fax | 310-829-6764
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Provider Business Mailing Address
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Address Line | 2001 SANTA MONICA BLVD STE 685W
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City | SANTA MONICA
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State | CA
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Zip | 90404-2186
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Country | US
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Telephone | 310-829-9400
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Fax | 310-829-6764
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN L KUCHENBECKER
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Credential | MD
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Telephone | 310-829-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | G30063
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License Number State | CA
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