Basic Information
| Provider Information | |||||||||
| NPI: | 1578553905 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FEINSTEIN | ||||||||
| FirstName: | EBEN | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1245 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 514 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900174810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134825141 | ||||||||
| FaxNumber: | 2134828128 | ||||||||
| Practice Location | |||||||||
| Address1: | 1245 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 514 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900174810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134825141 | ||||||||
| FaxNumber: | 2134828128 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 01/26/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | G35786 | CA | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 00G357860 | 05 | CA | MEDICAID |