Provider Demographics
NPI:1932465978
Name:JAN DAVID TEPPER, DPM, INC
Entity Type:Organization
Organization Name:JAN DAVID TEPPER, DPM, INC
Other - Org Name:FAMILY FOOT AND ANKLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:TEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:909-920-0884
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-474-9809
Mailing Address - Fax:
Practice Address - Street 1:984 W FOOTHILL BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3700
Practice Address - Country:US
Practice Address - Phone:909-920-0884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAN DAVID TEPPER, DPM, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-04
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site