MEDICARE: DR. DMITRIY ROMANENKO M.D.,

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	207Q00000X	Family Medicine Physician	A94512	CA
2	207V00000X	Obstetrics & Gynecology Physician	A94512	CA

General Provider Information

NPI Number	:	1881894715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DMITRIY ROMANENKO M.D.,

Provider Business Mailing Address
First Line	:	7660 BEVERLY BLVD
Second Line	:	#348
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-2757
Country	:	US
Telephone Number	:	323-240-1938
Fax Number	:

Provider Business Practice Location Address
First Line	:	5831 FIRESTONE BLVD STE E
Second Line	:
City	:	SOUTH GATE
State	:	CA
Zip	:	90280-3718
Country	:	US
Telephone Number	:	323-240-1938
Fax Number	:

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

Provider Enumeration Date	:	07/19/2007
Last Update Date	:	01/29/2026

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