Provider Demographics
NPI:1770542920
Name:KAUPKE, CHARLES JEFFREY (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JEFFREY
Last Name:KAUPKE
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 1:705 W LA VETA AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4447
Mailing Address - Country:US
Mailing Address - Phone:714-639-4601
Mailing Address - Fax:714-771-5389
Practice Address - Street 1:705 W LA VETA AVE STE 107
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4447
Practice Address - Country:US
Practice Address - Phone:714-639-4601
Practice Address - Fax:714-771-5389
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38574207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G385740Medicaid
CA00G385740Medicaid
CAWG38574GMedicare ID - Type Unspecified