Provider Demographics
NPI:1669642658
Name:ELLYN R. ASHIDA, M.D., INC.
Entity Type:Organization
Organization Name:ELLYN R. ASHIDA, M.D., INC.
Other - Org Name:PACIFIC ALLERGY & ASTHMA MEDICAL ASSOC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHIDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-944-9098
Mailing Address - Street 1:4201 TORRANCE BLVD
Mailing Address - Street 2:730
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4201 TORRANCE BLVD
Practice Address - Street 2:730
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4504
Practice Address - Country:US
Practice Address - Phone:310-944-9098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC40034207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C400340Medicaid
CA00C400340Medicaid
CAA37281Medicare UPIN