Healthcare Provider Details

I. General information

NPI: 1407241524
Provider Name (Legal Business Name): EDUARD DRANNIKOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 PACIFICA STE 130
IRVINE CA
92618-3316
US

IV. Provider business mailing address

114 PACIFICA STE 130
IRVINE CA
92618-3316
US

V. Phone/Fax

Practice location:
  • Phone: 949-257-2644
  • Fax: 888-355-7731
Mailing address:
  • Phone: 492-572-6449
  • Fax: 888-355-7731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA150694
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: