Healthcare Provider Details

I. General information

NPI: 1700928793
Provider Name (Legal Business Name): DR. BARRY GORDON KAMI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 UNIVERSITY AVE
BERKELEY CA
94703-1515
US

IV. Provider business mailing address

1811 UNIVERSITY AVE
BERKELEY CA
94703-1515
US

V. Phone/Fax

Practice location:
  • Phone: 510-845-1396
  • Fax:
Mailing address:
  • Phone: 510-845-1396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30835
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: