Active NPI
Marine Kupalyan
- Family Nurse Practitioner
- Los Angeles, CA
National Provider Identifier
1104451921
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 95034243
- Practice address
- 10833 Le Conte 22-387 MDCC
Los Angeles, CA 90095-1752 - Phone
- (310) 825-5930
- Fax
- (310) 794-7338
- NPI assigned
- Mar 12, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 95034243 | CA | Primary |
Addresses
Primary practice location
10833 Le Conte 22-387 MDCC
Los Angeles, CA 90095-1752
Mailing address
10833 Le Conte 22-387 MDCC
Los Angeles, CA 90095-1752
Phone (310) 825-5930
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95034243 | CA | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773187200000",
"number": "1104451921",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10833 LE CONTE 22-387 MDCC",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900951752",
"telephone_number": "310-825-5930",
"fax_number": "310-794-7338"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10833 LE CONTE 22-387 MDCC",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900951752",
"telephone_number": "310-825-5930",
"fax_number": "310-794-7338"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUPALYAN",
"first_name": "MARINE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-03-12",
"last_updated": "2026-03-11",
"certification_date": "2026-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": "CA",
"license": "95034243",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.