Provider Demographics
NPI:1760564702
Name:BARKHORDARIAN, SIAMAK (MD)
Entity Type:Individual
Prefix:
First Name:SIAMAK
Middle Name:
Last Name:BARKHORDARIAN
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:PO BOX 24218
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-0218
Mailing Address - Country:US
Mailing Address - Phone:310-880-3933
Mailing Address - Fax:310-693-2480
Practice Address - Street 1:8631 W 3RD ST STE 540E
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5909
Practice Address - Country:US
Practice Address - Phone:310-880-3933
Practice Address - Fax:310-693-2480
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA941482086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIH84048Medicare UPIN