Basic Information
| Provider Information | |||||||||
| NPI: | 1457356578 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YESSAIAN | ||||||||
| FirstName: | ANNIE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 31309 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900310309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234428500 | ||||||||
| FaxNumber: | 3232256284 | ||||||||
| Practice Location | |||||||||
| Address1: | 18133 VENTURA BLVD STE 402 | ||||||||
| Address2: | |||||||||
| City: | TARZANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913563645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183426011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | A54703 | CA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | 207VX0201X | A54703 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
ID Information
| ID | Type | State | Issuer | Description | 00A547030 | 05 | CA | MEDICAID |