Provider Demographics
NPI:1477857613
Name:JON B GREENFIELD, MD INC.
Entity type:Organization
Organization Name:JON B GREENFIELD, MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:GREENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-659-3400
Mailing Address - Street 1:434 S SAN VICENTE BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4108
Mailing Address - Country:US
Mailing Address - Phone:310-659-3400
Mailing Address - Fax:
Practice Address - Street 1:434 S SAN VICENTE BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4108
Practice Address - Country:US
Practice Address - Phone:310-659-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFE085AMedicare PIN
CA0835030001Medicare NSC