Provider Demographics
NPI:1063475135
Name:KOPPLE, JOEL D (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:D
Last Name:KOPPLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21840 NORMANDIE AVE
Mailing Address - Street 2:STE. 700
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2047
Mailing Address - Country:US
Mailing Address - Phone:310-222-5101
Mailing Address - Fax:310-320-5463
Practice Address - Street 1:21840 NORMANDIE AVE
Practice Address - Street 2:STE. 700
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2047
Practice Address - Country:US
Practice Address - Phone:310-222-5101
Practice Address - Fax:310-320-5463
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG10375207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G103750Medicaid
CAA37947Medicare UPIN
CA00G103750Medicaid
CAWG10375FMedicare ID - Type UnspecifiedPPIN
CAWG10375EMedicare ID - Type UnspecifiedPPIN