Provider Demographics
NPI:1851442792
Name:PAULSON, RICHARD JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOHN
Last Name:PAULSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1640 MARENGO ST
Mailing Address - Street 2:SUITE 505
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1036
Mailing Address - Country:US
Mailing Address - Phone:323-221-3270
Mailing Address - Fax:323-225-6284
Practice Address - Street 1:1127 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1400
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3901
Practice Address - Country:US
Practice Address - Phone:213-975-9990
Practice Address - Fax:213-975-9997
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-08-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG44995207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G449950OtherBLUE SHIELD
B97825Medicare UPIN