Provider Demographics
NPI:1669507273
Name:TSILYA BASS MD INC
Entity Type:Organization
Organization Name:TSILYA BASS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHISICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TSILYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-876-1500
Mailing Address - Street 1:1111 N FAIRFAX AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5363
Mailing Address - Country:US
Mailing Address - Phone:323-876-1500
Mailing Address - Fax:323-876-1515
Practice Address - Street 1:1111 N FAIRFAX AVE STE 109
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5363
Practice Address - Country:US
Practice Address - Phone:323-876-1500
Practice Address - Fax:323-876-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA636302084P0800X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A636300Medicaid
CAA63630Medicare PIN
CA00A636300Medicaid