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General NPI Number Information
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NPI Number | 1831461896
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Entity Type | Organization
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Legal Business Name | JOSHUA D. I. ELLENHORN, M.D., INC.
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Dates
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Enumeration Date | 02/06/2012
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Last Update Date | 06/17/2014
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Provider Practice Location Address
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Address Line | 8631 W 3RD ST STE 200E
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City | LOS ANGELES
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State | CA
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Zip | 90048-5901
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Country | US
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Telephone | 310-920-9248
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Fax | 310-289-1526
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Provider Business Mailing Address
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Address Line | 236 S LINDEN DR
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-3705
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Country | US
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Telephone | 310-920-9248
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Fax | 310-289-1526
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSHUA D.I. ELLENHORN
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Credential | M.D.
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Telephone | 310-920-9248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | G57872
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License Number State | CA
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