MEDICARE: EDWIN SAMUEL KULUBYA 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	207L00000X	Anesthesiology Physician	L1100	TX
2	208VP0000X	Pain Medicine Physician	G54189	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

General Provider Information

NPI Number	:	1922027218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWIN SAMUEL KULUBYA M. D.

Provider Business Mailing Address
First Line	:	3605 LONG BEACH BLVD STE 320
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-4025
Country	:	US
Telephone Number	:	714-234-7485
Fax Number	:	714-701-1071

Provider Business Practice Location Address
First Line	:	3605 LONG BEACH BLVD STE 320
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-4025
Country	:	US
Telephone Number	:	714-234-7485
Fax Number	:	714-701-1071

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	08/16/2021

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