MEDICARE: YELENA VAYNEROV 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	207QA0505X	Adult Medicine Physician	A38812	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A38812B	OTHER	CA	BLUE CROSS PROVIDER NUMBE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386673002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YELENA VAYNEROV M.D.

Provider Business Mailing Address
First Line	:	7559 SANTA MONICA BLVD # 201
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-6406
Country	:	US
Telephone Number	:	323-878-2523
Fax Number	:	323-878-2556

Provider Business Practice Location Address
First Line	:	7559 SANTA MONICA BLVD # 201
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-6406
Country	:	US
Telephone Number	:	323-878-2523
Fax Number	:	323-878-2556

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/09/2007

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