Provider Demographics
NPI:1336261684
Name:FAYNER, YURY (MD)
Entity Type:Individual
Prefix:DR
First Name:YURY
Middle Name:
Last Name:FAYNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:YURI
Other - Middle Name:
Other - Last Name:FAYNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 492387
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-8387
Mailing Address - Country:US
Mailing Address - Phone:760-446-1999
Mailing Address - Fax:760-446-1910
Practice Address - Street 1:900 N HERITAGE DR
Practice Address - Street 2:B
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-5536
Practice Address - Country:US
Practice Address - Phone:760-446-1999
Practice Address - Fax:760-446-1910
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1216452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology