MEDICARE: MR. SEAN MICHAEL KUPIEC MA, ATC, PES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	120402224	OTHER		NATABOC

General Provider Information

NPI Number	:	1053321216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SEAN MICHAEL KUPIEC MA, ATC, PES

Provider Business Mailing Address
First Line	:	5461 NEWCASTLE AVE APT 5
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-2000
Country	:	US
Telephone Number	:	315-292-0222
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 PASEO RANCHO CASTILLA
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90032-1875
Country	:	US
Telephone Number	:	315-292-0333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	03/05/2026

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