Provider Demographics
NPI:1336690098
Name:KAPSTROM, ALBERT BARUCH (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:BARUCH
Last Name:KAPSTROM
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 1:11635 MAYFIELD AVE
Mailing Address - Street 2:APT. 7
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5785
Mailing Address - Country:US
Mailing Address - Phone:310-948-1878
Mailing Address - Fax:213-351-2756
Practice Address - Street 1:600 S COMMONWEALTH AVE
Practice Address - Street 2:ROOM 903
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-4001
Practice Address - Country:US
Practice Address - Phone:213-351-8084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC27268251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare