Provider Demographics
NPI:1699871525
Name:ELLENHORN, JOSHUA (MD)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:
Last Name:ELLENHORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8631 W 3RD ST
Mailing Address - Street 2:SUITE 200E
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5901
Mailing Address - Country:US
Mailing Address - Phone:424-777-0939
Mailing Address - Fax:310-289-1526
Practice Address - Street 1:8631 W 3RD ST
Practice Address - Street 2:SUITE 200E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5901
Practice Address - Country:US
Practice Address - Phone:424-777-0939
Practice Address - Fax:310-289-1526
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG578722086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F62388Medicare UPIN
CAWG57872AMedicare ID - Type Unspecified
CA00G578720Medicaid