Provider Demographics
NPI:1578825824
Name:UNAL, ERSIN SELCUK (MD, PHD)
Entity Type:Individual
Prefix:
First Name:ERSIN
Middle Name:SELCUK
Last Name:UNAL
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 SOUTH ST STE 212
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1528
Mailing Address - Country:US
Mailing Address - Phone:562-272-7630
Mailing Address - Fax:562-272-7631
Practice Address - Street 1:3650 SOUTH ST STE 212
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712
Practice Address - Country:US
Practice Address - Phone:562-272-7630
Practice Address - Fax:562-272-7631
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND14492207R00000X, 207RH0003X
CAA163760207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1471181Medicaid