Healthcare Provider Details

I. General information

NPI: 1336673045
Provider Name (Legal Business Name): JORDAN KAPLAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5720 OBERLIN DR
SAN DIEGO CA
92121-1723
US

IV. Provider business mailing address

5309 ENDERBY CT
CALABASAS CA
91302-3163
US

V. Phone/Fax

Practice location:
  • Phone: 858-455-7558
  • Fax:
Mailing address:
  • Phone: 818-207-3626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA183990
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: