Provider Demographics
NPI:1942290770
Name:RUPNIK, JOHN KENYON (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:KENYON
Last Name:RUPNIK
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 1:3443 VILLA LN
Mailing Address - Street 2:SUITE 9
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6417
Mailing Address - Country:US
Mailing Address - Phone:707-253-8901
Mailing Address - Fax:707-253-1558
Practice Address - Street 1:3443 VILLA LN
Practice Address - Street 2:SUITE 9
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6417
Practice Address - Country:US
Practice Address - Phone:707-253-8901
Practice Address - Fax:707-253-1558
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27568207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G275680Medicaid
CA00G275680Medicaid
CA00G275680Medicare ID - Type Unspecified