Provider Demographics
NPI:1619525169
Name:BIGUN, ELENA
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:
Last Name:BIGUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18635 SOLEDAD CANYON RD STE 108
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-3723
Mailing Address - Country:US
Mailing Address - Phone:661-299-2525
Mailing Address - Fax:
Practice Address - Street 1:18635 SOLEDAD CANYON RD
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-3725
Practice Address - Country:US
Practice Address - Phone:661-299-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104120122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist