Healthcare Provider Details

I. General information

NPI: 1457582470
Provider Name (Legal Business Name): ELENA K AMIN MBCHB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELENA K GRANT MBCHB

II. Dates (important events)

Enumeration Date: 08/07/2009
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 16TH ST FL 5
SAN FRANCISCO CA
94158-2545
US

IV. Provider business mailing address

111 MICHIGAN AVE NW WW3 - CARDIOLOGY
WASHINGTON DC
20010-2916
US

V. Phone/Fax

Practice location:
  • Phone: 415-514-1521
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number073744
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number073744
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMD040435
License Number StateDC
# 4
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number154459
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: