Provider Demographics
NPI:1346353182
Name:PANOSSIAN, SEDA G (MD)
Entity Type:Individual
Prefix:DR
First Name:SEDA
Middle Name:G
Last Name:PANOSSIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 W SUNSET BLVD
Mailing Address - Street 2:650
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5861
Mailing Address - Country:US
Mailing Address - Phone:323-666-9491
Mailing Address - Fax:323-666-8332
Practice Address - Street 1:5000 W SUNSET BLVD
Practice Address - Street 2:650
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5861
Practice Address - Country:US
Practice Address - Phone:323-666-9491
Practice Address - Fax:323-666-8332
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45117174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA45117OtherMEDICAL LICENSE
CA00A451170Medicaid
CA00A451170Medicaid
CAE96505Medicare UPIN