Provider Demographics
NPI:1790707875
Name:OLEYNIKOV, YURI S (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:YURI
Middle Name:S
Last Name:OLEYNIKOV
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:415 N CRESCENT DR STE 220
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-6810
Mailing Address - Country:US
Mailing Address - Phone:323-655-3772
Mailing Address - Fax:323-655-5021
Practice Address - Street 1:444 S SAN VICENTE BLVD
Practice Address - Street 2:SUITE 1102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4165
Practice Address - Country:US
Practice Address - Phone:310-423-9640
Practice Address - Fax:310-423-9647
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA96434207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA96434Medicare PIN