Provider Demographics
NPI:1144506395
Name:YEVDAYEV, ELLA (MD)
Entity type:Individual
Prefix:DR
First Name:ELLA
Middle Name:
Last Name:YEVDAYEV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELLA
Other - Middle Name:
Other - Last Name:YEVDAYEV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4510 E PACIFIC COAST HWY STE 320
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-6926
Mailing Address - Country:US
Mailing Address - Phone:562-597-8273
Mailing Address - Fax:
Practice Address - Street 1:4510 E PACIFIC COAST STE 320
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-6926
Practice Address - Country:US
Practice Address - Phone:562-597-8273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115106207U00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFY5507352OtherDEA