Provider Demographics
NPI:1730210352
Name:MUSHER, GENNADY (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:GENNADY
Middle Name:
Last Name:MUSHER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6221 WILSHIRE BLVD
Mailing Address - Street 2:SUITE# 401
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5201
Mailing Address - Country:US
Mailing Address - Phone:323-655-3747
Mailing Address - Fax:323-932-0133
Practice Address - Street 1:6221 WILSHIRE BLVD
Practice Address - Street 2:SUITE# 401
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5201
Practice Address - Country:US
Practice Address - Phone:323-655-3747
Practice Address - Fax:323-932-0133
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA549042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15998Medicare PIN