Individual
ELENA R KVICHKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5762 BOLSA AVE STE 107, HUNTINGTON BEACH, CA 92649-1172
(714) 898-0362
(714) 893-3262
Mailing address
28364 S WESTERN AVE # 494, RANCHO PALOS VERDES, CA 90275-1434
(818) 618-2412
(714) 893-3262
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
A89532
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
486059932
UNITES STATES OF AMERICA PASSPORT
—
01
—
A8771500
CALIFORNIA DRIVER LICENSE
CA
Enumeration date
03/29/2007
Last updated
12/29/2021
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