Provider Demographics
NPI:1609819481
Name:DAVID B. SIEVERS, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DAVID B. SIEVERS, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEVERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-342-2123
Mailing Address - Street 1:18370 BURBANK BLVD
Mailing Address - Street 2:SUITE 607
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2804
Mailing Address - Country:US
Mailing Address - Phone:818-342-2123
Mailing Address - Fax:818-342-2141
Practice Address - Street 1:18370 BURBANK BLVD
Practice Address - Street 2:SUITE 607
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2804
Practice Address - Country:US
Practice Address - Phone:818-342-2123
Practice Address - Fax:818-342-2141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG16872208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G168720Medicaid
G16872OtherPRIVATE INSURANCEPIN
CA00G168720OtherBLUE SHIELD
A90456Medicare UPIN
CA00G168720Medicaid
G16872AMedicare PIN