Healthcare Provider Details

I. General information

NPI: 1255632543
Provider Name (Legal Business Name): GREGORY J. VIPOND, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 11/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N 5TH AVE SUITE 202
ARCADIA CA
91006-3710
US

IV. Provider business mailing address

51 N 5TH AVE SUITE 202
ARCADIA CA
91006-3710
US

V. Phone/Fax

Practice location:
  • Phone: 626-357-6222
  • Fax: 626-357-6848
Mailing address:
  • Phone: 626-357-6222
  • Fax: 626-357-6848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberA100020
License Number StateCA

VIII. Authorized Official

Name: DR. GREGORY J VIPOND
Title or Position: PRESIDENT
Credential: M.D.
Phone: 646-872-5215