Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 44328 | CA |
NPI | 1023138534 |
---|---|
Provider Name | Karson A. Kupiec |
First Address | Del Mar, CA 92014-2615 |
Second Address | Encinitas, CA 92024-2797 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 08/07/2007 |