Individual
JON MALLEN-ST. CLAIR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8635 W 3RD ST STE 590W, LOS ANGELES, CA 90048-6163
(310) 423-1220
(310) 423-1230
Mailing address
8635 W 3RD ST STE 590W, LOS ANGELES, CA 90048-6163
(310) 423-1220
(310) 423-1220
Taxonomy
Speciality
Code
Description
License number
State
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
A125470
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/26/2011
Last updated
01/21/2021
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