Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A170275 | CA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | A170275 | CA |
N | 207XX0801X | Orthopaedic Trauma Surgeon | A170275 | CA |
NPI | 1114312519 |
---|---|
Provider Name | Jason Scott Lipof |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Santa Monica, CA 90404-1101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2015 |
Last Update Date | 04/08/2021 |