Provider Demographics
NPI:1831461896
Name:JOSHUA D. I. ELLENHORN, M.D., INC.
Entity Type:Organization
Organization Name:JOSHUA D. I. ELLENHORN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:DI
Authorized Official - Last Name:ELLENHORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-920-9248
Mailing Address - Street 1:236 S LINDEN DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3705
Mailing Address - Country:US
Mailing Address - Phone:310-920-9248
Mailing Address - Fax:310-289-1526
Practice Address - Street 1:8631 W 3RD ST
Practice Address - Street 2:STE 200E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5901
Practice Address - Country:US
Practice Address - Phone:310-920-9248
Practice Address - Fax:310-289-1526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG578722086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty