MEDICARE: DR. HAYWARD LYNN EUBANKS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	G54388	CA

General Provider Information

NPI Number	:	1023039815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAYWARD LYNN EUBANKS M.D.

Provider Business Mailing Address
First Line	:	4477 W 118TH ST
Second Line	:	SUITE# 205
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-2255
Country	:	US
Telephone Number	:	310-679-0676
Fax Number	:	310-679-0087

Provider Business Practice Location Address
First Line	:	4477 W 118TH ST STE 205
Second Line	:
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-2257
Country	:	US
Telephone Number	:	310-679-0676
Fax Number	:	310-679-0087

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	10/13/2024

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