MEDICARE: DR. JENNIFER STARK D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	20A19767	CA
2	208200000X	Plastic Surgery Physician	303473	NY

General Provider Information

NPI Number	:	1063763548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER STARK D.O.

Provider Business Mailing Address
First Line	:	4373 PARK TERRACE DR UNIT 101
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-4631
Country	:	US
Telephone Number	:	805-449-7204
Fax Number	:

Provider Business Practice Location Address
First Line	:	4373 PARK TERRACE DR UNIT 101
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-4631
Country	:	US
Telephone Number	:	805-449-7204
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2012
Last Update Date	:	07/25/2025

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