Provider Demographics
NPI:1205842549
Name:KAUFMAN, EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:KAUFMAN
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 1:33971 SELVA RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3788
Mailing Address - Country:US
Mailing Address - Phone:949-488-3332
Mailing Address - Fax:949-488-7840
Practice Address - Street 1:33971 SELVA RD
Practice Address - Street 2:SUITE 125
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3788
Practice Address - Country:US
Practice Address - Phone:949-488-3332
Practice Address - Fax:949-488-7840
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA19663101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)