Provider Demographics
NPI:1457582470
Name:AMIN, ELENA K (MBCHB)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:K
Last Name:AMIN
Suffix:
Gender:F
Credentials:MBCHB
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:K
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBCHB
Mailing Address - Street 1:111 MICHIGAN AVE NW
Mailing Address - Street 2:WW3 - CARDIOLOGY
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2916
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 16TH ST FL 5
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-2545
Practice Address - Country:US
Practice Address - Phone:415-514-1521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA073744208000000X, 2080P0202X
DCMD0404352080P0202X
CA1544592080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics