Provider Demographics
NPI:1982642690
Name:KAPELOV, STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:KAPELOV
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 1:1516 COTNER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3303
Mailing Address - Country:US
Mailing Address - Phone:310-445-2951
Mailing Address - Fax:310-479-1459
Practice Address - Street 1:1516 COTNER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3303
Practice Address - Country:US
Practice Address - Phone:310-445-2951
Practice Address - Fax:310-479-1459
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG 642162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0106037Medicaid
CA00G642160Medicaid
CA00G642160OtherBLUE SHIELD
CAWG64216PMedicare PIN
CAWG64216SMedicare PIN
CAWG642160Medicare PIN
CAGR0106037Medicaid
CAWG64216YMedicare PIN
CAWG64216AAMedicare PIN
CA00G642160OtherBLUE SHIELD
CAF28839Medicare UPIN
CAWG64216RMedicare PIN
CAWG64216TMedicare PIN
CAWG64216ZMedicare PIN
CA00G642160Medicaid
CAWG64216BBMedicare PIN