Healthcare Provider Details

I. General information

NPI: 1699871525
Provider Name (Legal Business Name): JOSHUA ELLENHORN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST STE 880W
LOS ANGELES CA
90048-6155
US

IV. Provider business mailing address

8635 W 3RD ST STE 880W
LOS ANGELES CA
90048-6155
US

V. Phone/Fax

Practice location:
  • Phone: 310-289-1518
  • Fax: 310-289-1526
Mailing address:
  • Phone: 213-947-4938
  • Fax: 310-289-1526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberG57872
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG57872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: