MEDICARE: KURT OPENSHAW M.D.

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	2085R0204X	Vascular & Interventional Radiology Physician	G63924	CA
2	2085R0202X	Diagnostic Radiology Physician	G63924	CA

General Provider Information

NPI Number	:	1881693174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KURT OPENSHAW M.D.

Provider Business Mailing Address
First Line	:	1140 W LA VETA AVE STE 850
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-4218
Country	:	US
Telephone Number	:	714-560-4450
Fax Number	:	714-560-4455

Provider Business Practice Location Address
First Line	:	1140 W LA VETA AVE
Second Line	:	STE. 850
City	:	ORANGE
State	:	CA
Zip	:	92868-4225
Country	:	US
Telephone Number	:	714-560-4450
Fax Number	:	714-560-4455

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	06/06/2019

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Directions to “ KURT OPENSHAW M.D.” Practice Location

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