MEDICARE: ASYA KUPISK MD INC

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	2084P0800X	Psychiatry Physician	A35087	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4180916	OTHER	CA	MEDICAL

General Provider Information

NPI Number	:	1598933665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASYA KUPISK MD INC

Provider Business Mailing Address
First Line	:	11323 DONA LOLA DR
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604
Country	:	US
Telephone Number	:	323-876-6649
Fax Number	:	323-876-1835

Provider Business Practice Location Address
First Line	:	7779 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-3911
Country	:	US
Telephone Number	:	323-876-6649
Fax Number	:	323-876-1835

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ASYA KUPISK
Credential	:	MD
Telephone Number	:	323-876-6649

Provider Enumeration Date	:	02/12/2008
Last Update Date	:	12/10/2008

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