Provider Demographics
NPI:1689775892
Name:EMERT, SEMYON I (MD)
Entity Type:Individual
Prefix:
First Name:SEMYON
Middle Name:I
Last Name:EMERT
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 1:1415 1/2 N GARDNER ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-4156
Mailing Address - Country:US
Mailing Address - Phone:323-850-0564
Mailing Address - Fax:
Practice Address - Street 1:1417 1/2N GARDNER ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-4156
Practice Address - Country:US
Practice Address - Phone:323-646-2506
Practice Address - Fax:323-850-0784
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37223207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A372230Medicaid
CAA84987Medicare UPIN
CAA37223Medicare ID - Type Unspecified