Basic Information
| Provider Information | |||||||||
| NPI: | 1831120591 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEMERJIAN | ||||||||
| FirstName: | AVEDIK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD, FACP, FASN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3300 E SOUTH ST | ||||||||
| Address2: | 308 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908054549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626303111 | ||||||||
| FaxNumber: | 5626303107 | ||||||||
| Practice Location | |||||||||
| Address1: | 3300 E SOUTH ST | ||||||||
| Address2: | 308 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908054549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626303111 | ||||||||
| FaxNumber: | 5626303107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 04/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | A46344 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 00A463440 | 05 | CA | MEDICAID |