Healthcare Provider Details

I. General information

NPI: 1780935130
Provider Name (Legal Business Name): DAWN ELIASHIV MD INC. A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2012
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST STE 1080W
LOS ANGELES CA
90048-6183
US

IV. Provider business mailing address

PO BOX 11448
BEVERLY HILLS CA
90213-4448
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-2391
  • Fax: 310-388-5212
Mailing address:
  • Phone: 310-659-2391
  • Fax: 310-388-5212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberA52594
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA52594
License Number StateCA

VIII. Authorized Official

Name: DR. DAWN S ELIASHIV
Title or Position: MEDICAL DOCTOR
Credential: M.D
Phone: 310-659-2391