Provider Demographics
NPI:1912939604
Name:KAUFMAN, HOWARD S (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:S
Last Name:KAUFMAN
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:PO BOX 50487
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91115-0487
Mailing Address - Country:US
Mailing Address - Phone:626-397-5896
Mailing Address - Fax:626-397-5899
Practice Address - Street 1:10 PICO ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3201
Practice Address - Country:US
Practice Address - Phone:626-397-5896
Practice Address - Fax:626-397-5899
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50932208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C509320Medicaid
CA020053154OtherMEDICARE RAILROAD PIN
CA00C509320C29OtherCAL OPTIMA PIN
CA00C509320OtherBLUE SHIELD PIN
CAWC50932AMedicare PIN
CA00C509320OtherBLUE SHIELD PIN