Healthcare Provider Details

I. General information

NPI: 1508932740
Provider Name (Legal Business Name): JEROME L. LIPIN, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8733 BEVERLY BLVD SUITE 200
WEST HOLLYWOOD CA
90048-1827
US

IV. Provider business mailing address

8733 BEVERLY BLVD SUITE 200
WEST HOLLYWOOD CA
90048-1827
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-3981
  • Fax: 316-652-3155
Mailing address:
  • Phone: 310-652-3981
  • Fax: 316-652-3155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA15723
License Number StateCA

VIII. Authorized Official

Name: DR. JEROME L LIPIN
Title or Position: PRESIDENT
Credential: M.D., M.S.
Phone: 310-652-3981