MEDICARE: DR. MICHEL H ELYSON D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	40605	CA
2	1223G0001X	General Practice Dentistry	40605	CA

General Provider Information

NPI Number	:	1235268178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHEL H ELYSON D.D.S.

Provider Business Mailing Address
First Line	:	4975 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-3131
Country	:	US
Telephone Number	:	323-263-2125
Fax Number	:

Provider Business Practice Location Address
First Line	:	4975 WHITTIER BLVD.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-2525
Country	:	US
Telephone Number	:	323-263-2125
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	09/02/2014

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