Provider Demographics
NPI:1316022924
Name:SEMENIUK, GEORGE BERNARD (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:BERNARD
Last Name:SEMENIUK
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:PO BOX 512185
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1601 AVOCADO AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7798
Practice Address - Country:US
Practice Address - Phone:949-763-2204
Practice Address - Fax:949-536-8036
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61824207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
W13856AOtherMEDICARE GROUP PTAN
W13856OtherMEDICARE GROUP PTAN
WA61824AMedicare PIN
W13856OtherMEDICARE GROUP PTAN
CAG83275Medicare UPIN
DW653YMedicare PIN