Healthcare Provider Details

I. General information

NPI: 1689875692
Provider Name (Legal Business Name): NATALIYA M. KUSHNIR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 WOOLSEY ST 314
BERKELEY CA
94705-1976
US

IV. Provider business mailing address

2320 WOOLSEY ST 314
BERKELEY CA
94705-1976
US

V. Phone/Fax

Practice location:
  • Phone: 925-270-5119
  • Fax: 510-666-0916
Mailing address:
  • Phone: 925-270-5119
  • Fax: 510-666-0916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA83416
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: