Active NPI
Kirill Lipa, PA-C
- Trauma Surgery Physician
- Pomona, CA
National Provider Identifier
1154134088
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Trauma Surgery Physician
- License
- 65761
- Practice address
- 1798 N Garey Ave
Pomona, CA 91767-2918 - Phone
- (909) 865-9500
- NPI assigned
- Jan 27, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Trauma Surgery Physician | 2086S0127X | 65761 | CA | Primary |
Addresses
Primary practice location
1798 N Garey Ave
Pomona, CA 91767-2918
Mailing address
101 Bucknell Ave Unit 310
Claremont, CA 91711-4945
Phone (818) 388-5093
Other practice location 1
160 E Artesia St Ste 310
Pomona, CA 91767-2922
Phone (909) 469-9477
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 65761 | CA | MD | Trauma Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1737936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1737936000000",
"number": "1154134088",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 BUCKNELL AVE UNIT 310",
"city": "CLAREMONT",
"state": "CA",
"postal_code": "917114945",
"telephone_number": "818-388-5093"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1798 N GAREY AVE",
"city": "POMONA",
"state": "CA",
"postal_code": "917672918",
"telephone_number": "909-865-9500"
}
],
"practiceLocations": [
{
"address_1": "160 E Artesia St Ste 310",
"address_purpose": "LOCATION",
"city": "Pomona",
"state": "CA",
"postal_code": "917672922",
"country_code": "US",
"telephone_number": "909-469-9477",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LIPA",
"first_name": "KIRILL",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-01-27",
"last_updated": "2025-01-27",
"certification_date": "2025-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0127X",
"taxonomy_group": "",
"desc": "Surgery, Trauma Surgery",
"state": "CA",
"license": "65761",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pomona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.