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General NPI Number Information
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NPI Number | 1235451121
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Entity Type | Organization
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Legal Business Name | EDWIN O. YELLIN MD, INC
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Dates
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Enumeration Date | 02/19/2010
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 9549 MELVIN AVE
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City | NORTHRIDGE
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State | CA
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Zip | 91324-2134
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Country | US
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Telephone | 818-772-2163
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Fax | 818-772-8131
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Provider Business Mailing Address
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Address Line | PO BOX 280220
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City | NORTHRIDGE
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State | CA
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Zip | 91328-0220
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Country | US
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Telephone | 818-772-2163
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Fax | 818-772-8131
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWIN O. YELLIN
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Credential | MD
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Telephone | 818-772-2163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A40190
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License Number State | CA
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