Provider Demographics
NPI:1659403988
Name:FELDMAN, EDWARD J (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8635 WEST THIRD STREET
Mailing Address - Street 2:SUITE 960W
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6106
Mailing Address - Country:US
Mailing Address - Phone:310-652-8031
Mailing Address - Fax:310-967-0131
Practice Address - Street 1:8635 WEST THIRD STREET
Practice Address - Street 2:SUITE 960W
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6106
Practice Address - Country:US
Practice Address - Phone:310-652-8031
Practice Address - Fax:310-967-0131
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC32700207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC32700OtherSTATE LICENSE
CAAF6761325OtherDEA NUMBER
CA00C327000Medicare ID - Type UnspecifiedPROVIDER #
CAC32700OtherSTATE LICENSE