Provider Demographics
NPI:1134328859
Name:SARKISYAN, GRANT G (MD)
Entity Type:Individual
Prefix:MR
First Name:GRANT
Middle Name:G
Last Name:SARKISYAN
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 1:3791 KATELLA AVE
Mailing Address - Street 2:#201 VASCULAR & GENERAL SURGERY ASSOC.
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3105
Mailing Address - Country:US
Mailing Address - Phone:562-596-6736
Mailing Address - Fax:562-596-5387
Practice Address - Street 1:3791 KATELLA AVE
Practice Address - Street 2:#201 VASCULAR & GENERAL SURGERY ASSOC.
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3105
Practice Address - Country:US
Practice Address - Phone:562-596-6736
Practice Address - Fax:562-596-5387
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84533208C00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A845330Medicaid
CA00A845330OtherBLUE SHIELD PIN
CAA84533OtherLIC
CAI27906OtherUPIN NUMBER
CAI27906OtherUPIN NUMBER
CA00A845330Medicaid