Provider Demographics
NPI:1407856354
Name:LIPKIN, JOEL J (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:J
Last Name:LIPKIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32565-B GOLDEN LANTERN STREET #142
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3261
Mailing Address - Country:US
Mailing Address - Phone:714-878-2002
Mailing Address - Fax:
Practice Address - Street 1:5907 LANKERSHIM BLVD
Practice Address - Street 2:
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-1006
Practice Address - Country:US
Practice Address - Phone:818-980-3073
Practice Address - Fax:877-340-3470
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2802213E00000X
CAE4839213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT-11473Medicare UPIN
CAE4839Medicare UPIN