Provider Demographics
NPI:1235451121
Name:EDWIN O. YELLIN MD, INC
Entity Type:Organization
Organization Name:EDWIN O. YELLIN MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:O
Authorized Official - Last Name:YELLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-772-2163
Mailing Address - Street 1:PO BOX 280220
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91328-0220
Mailing Address - Country:US
Mailing Address - Phone:818-772-2163
Mailing Address - Fax:818-772-8131
Practice Address - Street 1:9549 MELVIN AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-2134
Practice Address - Country:US
Practice Address - Phone:818-772-2163
Practice Address - Fax:818-772-8131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40190174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A401900Medicaid
CA1467670307OtherNPI
CAA40190Medicare Oscar/Certification
CA1467670307OtherNPI