Basic Information
| Provider Information | |||||||||
| NPI: | 1235277195 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | LYTTON | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 W 3RD ST | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900571932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2132075635 | ||||||||
| FaxNumber: | 2132075889 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 W 3RD ST | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900571932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2132075635 | ||||||||
| FaxNumber: | 2132075889 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0117X | G40156 | CA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
| ID | Type | State | Issuer | Description | W14159 | 05 | CA | MEDICAID |