Provider Demographics
NPI:1821019456
Name:MEMSIC, LESLIE (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:MEMSIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 N BEDFORD DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4310
Mailing Address - Country:US
Mailing Address - Phone:310-278-8200
Mailing Address - Fax:310-278-8230
Practice Address - Street 1:436 N BEDFORD DR
Practice Address - Street 2:STE 105
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4323
Practice Address - Country:US
Practice Address - Phone:310-278-8200
Practice Address - Fax:310-278-8230
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2016-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG4963802086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G496380Medicaid
CA00G496380Medicaid
CAE02687Medicare UPIN