Healthcare Provider Details

I. General information

NPI: 1134328859
Provider Name (Legal Business Name): GRANT G. SARKISYAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3791 KATELLA AVE #201 VASCULAR & GENERAL SURGERY ASSOC.
LOS ALAMITOS CA
90720-3105
US

IV. Provider business mailing address

3791 KATELLA AVE #201 VASCULAR & GENERAL SURGERY ASSOC.
LOS ALAMITOS CA
90720-3105
US

V. Phone/Fax

Practice location:
  • Phone: 562-596-6736
  • Fax: 562-596-5387
Mailing address:
  • Phone: 562-596-6736
  • Fax: 562-596-5387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA84533
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberA84533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: