Provider Demographics
NPI:1598707341
Name:EPSTEIN, MARK J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:EPSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 260184
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91426-0184
Mailing Address - Country:US
Mailing Address - Phone:818-368-1802
Mailing Address - Fax:818-360-8588
Practice Address - Street 1:16955 VANOWEN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4542
Practice Address - Country:US
Practice Address - Phone:818-343-0700
Practice Address - Fax:818-996-8670
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC25413174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB50621Medicare UPIN