Provider Demographics
NPI:1467670307
Name:YELLIN, EDWIN O (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:O
Last Name:YELLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9549 MELVIN AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-2134
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40190207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A401900Medicaid
CA00A401900Medicaid
A88520Medicare UPIN
CAA40190Medicare PIN