MEDICARE: VICTORIA OLSHANSKY

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	46315	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1194910588	OTHER	CA	NPI TYPE 2

General Provider Information

NPI Number	:	1700926706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA OLSHANSKY

Provider Business Mailing Address
First Line	:	1136 N FAIRFAX AVE
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5307
Country	:	US
Telephone Number	:	323-650-6936
Fax Number	:	323-654-2593

Provider Business Practice Location Address
First Line	:	1136 N FAIRFAX AVE
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5307
Country	:	US
Telephone Number	:	323-650-6936
Fax Number	:	323-654-2593

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	05/07/2021

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Directions to “ VICTORIA OLSHANSKY ” Practice Location

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