Provider Demographics
NPI:1891708368
Name:MADIKIANS, ANDRANIK (MD)
Entity type:Individual
Prefix:
First Name:ANDRANIK
Middle Name:
Last Name:MADIKIANS
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 1:5767 W CENTURY BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-825-9124
Mailing Address - Fax:310-794-6623
Practice Address - Street 1:10833 LE CONTE AVE
Practice Address - Street 2:12-441 MDCC
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-3075
Practice Address - Country:US
Practice Address - Phone:310-825-9124
Practice Address - Fax:310-794-6623
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA563832080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A563830Medicaid
CAGR0053510Medicaid
CAGR0053510Medicaid
CA00A563830Medicaid
CAW11810Medicare ID - Type UnspecifiedGROUP NUMBER