Healthcare Provider Details

I. General information

NPI: 1780610113
Provider Name (Legal Business Name): JASON SCOTT HAMILTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 09/10/2023
Certification Date: 09/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W 3RD ST SUITE 945E
LOS ANGELES CA
90048-5901
US

IV. Provider business mailing address

6240 W MANCHESTER AVE
LOS ANGELES CA
90045-3801
US

V. Phone/Fax

Practice location:
  • Phone: 804-855-8023
  • Fax:
Mailing address:
  • Phone: 310-657-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberA79242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: