Healthcare Provider Details

I. General information

NPI: 1053696484
Provider Name (Legal Business Name): BRIAN M. KINNEY M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S SPALDING DR SUITE 330
BEVERLY HILLS CA
90212-1800
US

IV. Provider business mailing address

120 S SPALDING DR SUITE 330
BEVERLY HILLS CA
90212-1800
US

V. Phone/Fax

Practice location:
  • Phone: 310-858-1042
  • Fax: 310-274-2494
Mailing address:
  • Phone: 310-858-1042
  • Fax: 310-274-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG51775
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberG51775
License Number StateCA

VIII. Authorized Official

Name: DR. BRIAN M KINNEY
Title or Position: PRESIDENT
Credential: M.D
Phone: 310-858-1042