Provider Demographics
NPI:1063414027
Name:BARSEMIAN, WANES (MD)
Entity type:Individual
Prefix:
First Name:WANES
Middle Name:
Last Name:BARSEMIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 E 120-TH STREET
Mailing Address - Street 2:MLKCH
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059
Mailing Address - Country:US
Mailing Address - Phone:424-338-8000
Mailing Address - Fax:424-338-8962
Practice Address - Street 1:1680 E 120-TH STREET
Practice Address - Street 2:MARTIN LUTHER KING COM HOSPITAL
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059
Practice Address - Country:US
Practice Address - Phone:424-338-8000
Practice Address - Fax:424-338-8962
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047393207R00000X
CA66186208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA047393OtherSTATE LICENSE
CAA66186OtherSTATE LICE
H04149Medicare UPIN
GA989448OtherBCBS OF GA