Provider Demographics
NPI:1861495301
Name:KAUFMAN, JEFFREY EVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:EVAN
Last Name:KAUFMAN
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 1:3 LACERTA
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-3622
Mailing Address - Country:US
Mailing Address - Phone:714-973-4600
Mailing Address - Fax:949-502-5646
Practice Address - Street 1:3 LACERTA
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92603-3622
Practice Address - Country:US
Practice Address - Phone:714-973-4600
Practice Address - Fax:949-502-5646
Is Sole Proprietor?:No
Enumeration Date:2005-05-28
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35977208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G359770Medicaid
CAG35977Medicare PIN
CAA46538Medicare UPIN