Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VG0400X | Gynecologist | A54703 | CA |
Y | 207VX0201X | Gynecologic Oncologist | A54703 | CA |
NPI | 1457356578 |
---|---|
Provider Name | Annie A Yessaian |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Tarzana, CA 91356-3645 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2005 |
Last Update Date | 16/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A547030 | (05) | CA |
H05698 | (02) | CA |