Provider Demographics
NPI:1790401529
Name:ZAK, YELENA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:YELENA
Middle Name:
Last Name:ZAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4430 NOBLE AVE APT 105
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-4068
Mailing Address - Country:US
Mailing Address - Phone:773-225-5386
Mailing Address - Fax:
Practice Address - Street 1:8635 W 3RD ST STE 590W
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6163
Practice Address - Country:US
Practice Address - Phone:310-423-1220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA61568207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty