Provider Demographics
NPI:1255519104
Name:ELAINEMD, INC
Entity type:Organization
Organization Name:ELAINEMD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-279-8199
Mailing Address - Street 1:466 FOOTHILL BLVD
Mailing Address - Street 2:# 181
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-3518
Mailing Address - Country:US
Mailing Address - Phone:818-279-8199
Mailing Address - Fax:
Practice Address - Street 1:466 FOOTHILL BLVD
Practice Address - Street 2:# 181
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-3518
Practice Address - Country:US
Practice Address - Phone:818-279-8199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-03
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47836261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center