Provider Demographics
NPI:1710995782
Name:MATCH POINT, INC.
Entity Type:Organization
Organization Name:MATCH POINT, INC.
Other - Org Name:CULVER WEST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DIMITRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BIGUN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:310-344-3462
Mailing Address - Street 1:12095 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-2626
Mailing Address - Country:US
Mailing Address - Phone:310-391-5238
Mailing Address - Fax:310-391-0359
Practice Address - Street 1:12095 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-2626
Practice Address - Country:US
Practice Address - Phone:310-391-5238
Practice Address - Fax:310-391-0359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY460743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4786040001Medicare ID - Type UnspecifiedMEDICARE