Provider Demographics
NPI:1588843379
Name:THOMAS J.HOPKINS, MD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:THOMAS J.HOPKINS, MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:818-981-2288
Mailing Address - Street 1:16030 VENTURA BLVD
Mailing Address - Street 2:400
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2731
Mailing Address - Country:US
Mailing Address - Phone:310-833-1820
Mailing Address - Fax:310-833-1830
Practice Address - Street 1:16030 VENTURA BLVD
Practice Address - Street 2:400
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2731
Practice Address - Country:US
Practice Address - Phone:310-833-1820
Practice Address - Fax:310-833-1830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71795174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG71795Medicare UPIN