Provider Demographics
NPI:1104187913
Name:SAMUEL L. KIPPER, M.D., INC.
Entity Type:Organization
Organization Name:SAMUEL L. KIPPER, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:KIPPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-285-1506
Mailing Address - Street 1:28492 CALLE PINON
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-5803
Mailing Address - Country:US
Mailing Address - Phone:949-285-1506
Mailing Address - Fax:
Practice Address - Street 1:28492 CALLE PINON
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-5803
Practice Address - Country:US
Practice Address - Phone:949-285-1506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34500171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty