Provider Demographics
NPI:1962569616
Name:FEYGIN, POLINA (MD)
Entity type:Individual
Prefix:DR
First Name:POLINA
Middle Name:
Last Name:FEYGIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30822 VIA RIVERA
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-5343
Mailing Address - Country:US
Mailing Address - Phone:310-619-9528
Mailing Address - Fax:310-206-0209
Practice Address - Street 1:30822 VIA RIVERA
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-5343
Practice Address - Country:US
Practice Address - Phone:310-619-9528
Practice Address - Fax:310-206-0209
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67378208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G673780Medicaid
CAF89405Medicare UPIN
CA00G673780Medicaid