Healthcare Provider Details

I. General information

NPI: 1053600940
Provider Name (Legal Business Name): JASON AARON DAVIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3828 E IMPERIAL HWY STE 300
LYNWOOD CA
90262
US

IV. Provider business mailing address

17525 VENTURA BLVD STE 210
ENCINO CA
91316-5111
US

V. Phone/Fax

Practice location:
  • Phone: 310-900-4788
  • Fax: 310-900-2704
Mailing address:
  • Phone: 818-986-2861
  • Fax: 818-638-5762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA116229
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberA116229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: