Healthcare Provider Details

I. General information

NPI: 1750575247
Provider Name (Legal Business Name): JASON LITAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 SANTA MONICA BLVD SUITE 990-W
SANTA MONICA CA
90404-2102
US

IV. Provider business mailing address

2001 SANTA MONICA BLVD SUITE 990-W
SANTA MONICA CA
90404-2102
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-4484
  • Fax: 310-829-4481
Mailing address:
  • Phone: 310-829-4484
  • Fax: 310-829-4481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA118111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: