Provider Demographics
NPI:1033490081
Name:KIPPER, CAROLYN LEE (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:LEE
Last Name:KIPPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 N ARDEN DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-3509
Mailing Address - Country:US
Mailing Address - Phone:310-278-4004
Mailing Address - Fax:
Practice Address - Street 1:609 N ARDEN DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-3509
Practice Address - Country:US
Practice Address - Phone:310-278-4004
Practice Address - Fax:310-278-6798
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-05
Last Update Date:2011-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41288208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics