Provider Demographics
NPI:1881784544
Name:KIPROV, ROSE SHOSHANA (MD)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:SHOSHANA
Last Name:KIPROV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHOSHANA
Other - Middle Name:ROSE V
Other - Last Name:KIPROV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1 GLORIETTA CT
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-3551
Mailing Address - Country:US
Mailing Address - Phone:925-254-1349
Mailing Address - Fax:
Practice Address - Street 1:15051 HESPERIAN BLVD
Practice Address - Street 2:STE A
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-3536
Practice Address - Country:US
Practice Address - Phone:510-276-1212
Practice Address - Fax:510-276-1313
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36455207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A364550Medicare UPIN
CA4504090001Medicare NSC