Provider Demographics
NPI:1609871920
Name:KANDEL, ELENA F (MD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:F
Last Name:KANDEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8510 BALBOA BLVD
Mailing Address - Street 2:STE 150
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-5810
Mailing Address - Country:US
Mailing Address - Phone:818-637-2000
Mailing Address - Fax:818-242-8761
Practice Address - Street 1:12660 RIVERSIDE DR
Practice Address - Street 2:STE 225
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91607-3469
Practice Address - Country:US
Practice Address - Phone:818-755-0265
Practice Address - Fax:818-753-9074
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78040207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A780400Medicaid
CAH90480Medicare UPIN
CA00A780400Medicaid