Provider Demographics
NPI:1548208978
Name:ANIS, JOHN ONSSY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ONSSY
Last Name:ANIS
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 1:914 ARIZONA AVE
Mailing Address - Street 2:#1
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1849
Mailing Address - Country:US
Mailing Address - Phone:310-592-5323
Mailing Address - Fax:
Practice Address - Street 1:4929 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1702
Practice Address - Country:US
Practice Address - Phone:818-907-4570
Practice Address - Fax:818-907-2814
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77310207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A773100Medicaid
CAWA77310HMedicare PIN
CAWA73310Medicare PIN
CA00A773100Medicaid
CAH95736Medicare UPIN
CAWA77310EMedicare PIN