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General NPI Number Information
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NPI Number | 1518310507
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Entity Type | Individual
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Provider Name | SETH JUSTIN LICHTENSTEIN M.D
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Gender | Male
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Dates
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Enumeration Date | 07/14/2016
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Last Update Date | 11/22/2022
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Provider Practice Location Address
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Address Line | 2001 SANTA MONICA BLVD STE 280W
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City | SANTA MONICA
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State | CA
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Zip | 90404-2172
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Country | US
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Telephone | 310-829-7678
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Fax | 310-829-6889
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Provider Business Mailing Address
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Address Line | 1717 WEST CONGRESS PARKWAY, 1042 KELLOGG
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City | CHICAGO
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State | IL
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Zip | 60612
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Country | US
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Telephone | 312-942-5000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 125069300
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A161705
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License Number State | CA
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