Provider Demographics
NPI:1639308075
Name:FEYISSA, GIRUM K (MD)
Entity Type:Individual
Prefix:DR
First Name:GIRUM
Middle Name:K
Last Name:FEYISSA
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 1:3745 CHESAPEAKE AVE
Mailing Address - Street 2:APT#307
Mailing Address - City:LOSANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016
Mailing Address - Country:US
Mailing Address - Phone:132-394-5396
Mailing Address - Fax:
Practice Address - Street 1:10945 LECONTE AVE
Practice Address - Street 2:SUITE 2339
Practice Address - City:LOSANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095
Practice Address - Country:US
Practice Address - Phone:310-825-6301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107357207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine