Provider Demographics
NPI:1497901565
Name:CUPP, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CUPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3939 J ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3636
Mailing Address - Country:US
Mailing Address - Phone:916-454-4861
Mailing Address - Fax:916-454-3603
Practice Address - Street 1:3939 J ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3636
Practice Address - Country:US
Practice Address - Phone:916-454-4861
Practice Address - Fax:916-454-3603
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA120754207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A1207540Medicaid
CA0A1207540Medicaid
CACA130934Medicare PIN