Organization
DALE PROKUPEK MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DALE A PROKUPEK M.D. (OWNER)
(310) 360-6807
Entity
Organization
Contact information
Practice address
8641 WILSHIRE BLVD, 100, BEVERLY HILLS, CA 90211-2900
(310) 360-6807
(310) 360-6683
Mailing address
1710 N FAIRFAX AVE, LOS ANGELES, CA 90046-2136
(310) 360-6807
(310) 360-6683
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
G71035
CA
208D00000X
General Practice Physician
G71035
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G71035A
MEDICARE PTAN
CA
Enumeration date
03/22/2011
Last updated
03/22/2011
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