Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 101077 | CA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 34607 | TX |
N | 204E00000X | Oral & Maxillofacial Surgeon | 157675 | CA |
N | 204E00000X | Oral & Maxillofacial Surgeon | 34607 | TX |
NPI | 1225322019 |
---|---|
Provider Name | Kevin Coppelson |
First Address | Los Angeles, CA 90024-3906 |
Second Address | Los Angeles, CA 90024 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2011 |
Last Update Date | 31/10/2019 |