Provider Demographics
NPI:1417691411
Name:JEFFREY SCOTT KOPSTEIN, D.O., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JEFFREY SCOTT KOPSTEIN, D.O., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:KOPSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-437-1588
Mailing Address - Street 1:310 SOUTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91377-3842
Mailing Address - Country:US
Mailing Address - Phone:818-437-1588
Mailing Address - Fax:
Practice Address - Street 1:310 SOUTHRIDGE DR
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:CA
Practice Address - Zip Code:91377-3842
Practice Address - Country:US
Practice Address - Phone:818-437-1588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center