Provider Demographics
NPI:1801963996
Name:EPSTEIN, ERVIN JR (MD)
Entity type:Individual
Prefix:DR
First Name:ERVIN
Middle Name:
Last Name:EPSTEIN
Suffix:JR
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 1:400 - 30TH STREET
Mailing Address - Street 2:SUITE 205
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3305
Mailing Address - Country:US
Mailing Address - Phone:510-444-8282
Mailing Address - Fax:510-444-8284
Practice Address - Street 1:400 30TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3306
Practice Address - Country:US
Practice Address - Phone:510-444-8282
Practice Address - Fax:510-444-8284
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22751207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A227510Medicaid
CA7158129OtherCCS
CA030854OtherHILL PHYSICIANS
CA00A227510OtherBLUE SHILED
CA7158129OtherCCS
CAA23229Medicare UPIN