Provider Demographics
NPI:1619902764
Name:BULPITT, KEN JIRO (MD)
Entity Type:Individual
Prefix:
First Name:KEN
Middle Name:JIRO
Last Name:BULPITT
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 1:1000 VETERAN AVE
Mailing Address - Street 2:DIVISION OF RHEUMATOLOGY
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1670
Mailing Address - Country:US
Mailing Address - Phone:310-743-5203
Mailing Address - Fax:
Practice Address - Street 1:UCLA MEDICAL GROUP
Practice Address - Street 2:200 MEDICAL PLAZA, B365
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-743-5203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59166207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1619902764Medicaid
CAE84197Medicare UPIN
CAGS109ZMedicare PIN
CA1619902764Medicaid