Healthcare Provider Details

I. General information

NPI: 1275807968
Provider Name (Legal Business Name): JEROME LIPIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 02/28/2012
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: 310-652-3906
Mailing address:
  • Phone: 310-652-3981
  • Fax: 310-652-3906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA015723
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: