Provider Demographics
NPI:1104071869
Name:WERNIK, EDAN (MD)
Entity type:Individual
Prefix:DR
First Name:EDAN
Middle Name:
Last Name:WERNIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:450 E SPRING ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1625
Mailing Address - Country:US
Mailing Address - Phone:562-933-0050
Mailing Address - Fax:562-933-0078
Practice Address - Street 1:450 E SPRING ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1625
Practice Address - Country:US
Practice Address - Phone:562-933-0050
Practice Address - Fax:562-933-0078
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-22
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA105632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine