Healthcare Provider Details

I. General information

NPI: 1609871920
Provider Name (Legal Business Name): ELENA F KANDEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 12/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12660 RIVERSIDE DR STE 225
N HOLLYWOOD CA
91607-3469
US

IV. Provider business mailing address

8510 BALBOA BLVD STE 150
NORTHRIDGE CA
91325-5810
US

V. Phone/Fax

Practice location:
  • Phone: 818-755-0265
  • Fax: 818-753-9074
Mailing address:
  • Phone: 818-637-2000
  • Fax: 818-242-8761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA78040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: