Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | G12848 | CA |
NPI | 1003818121 |
---|---|
Provider Name | Dr. Kenneth B Epstein |
First Address | Northridge, CA 91325-3583 |
Second Address | Northridge, CA 91325-3583 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 06/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G128480 | (05) | CA |
A38806 | (02) | CA |