Healthcare Provider Details

I. General information

NPI: 1194038604
Provider Name (Legal Business Name): JENNIFER LANG MD INC A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 02/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10309 SANTA MONICA BLVD #300
LOS ANGELES CA
90025-5007
US

IV. Provider business mailing address

10309 SANTA MONICA BLVD SUITE 300
LOS ANGELES CA
90025-5007
US

V. Phone/Fax

Practice location:
  • Phone: 310-285-9900
  • Fax: 310-553-7020
Mailing address:
  • Phone: 310-282-9900
  • Fax: 310-553-7020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberA96071
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA96071
License Number StateCA

VIII. Authorized Official

Name: JENNIFER LANG
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 917-282-7986