Provider Demographics
NPI:1407241524
Name:DRANNIKOV, EDUARD (MD)
Entity type:Individual
Prefix:
First Name:EDUARD
Middle Name:
Last Name:DRANNIKOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 PACIFICA STE 130
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3316
Mailing Address - Country:US
Mailing Address - Phone:492-572-6449
Mailing Address - Fax:888-355-7731
Practice Address - Street 1:114 PACIFICA STE 130
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3316
Practice Address - Country:US
Practice Address - Phone:949-257-2644
Practice Address - Fax:888-355-7731
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA150694207Q00000X
MI4301115855207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine