Individual
JOHANN KUPPERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
525 LILLY RD NE, OLYMPIA, WA 98506
(360) 493-7525
Mailing address
3800 14TH AVE SE, APT A7, LACEY, WA 98503
(626) 838-8251
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
ML61164276
WA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/12/2021
Last updated
02/22/2022
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