Healthcare Provider Details

I. General information

NPI: 1629269014
Provider Name (Legal Business Name): IRINA KAMINSKY M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N JACKSON AVE
SAN JOSE CA
95116-1603
US

IV. Provider business mailing address

2100 POWELL ST STE 920
EMERYVILLE CA
94608-1826
US

V. Phone/Fax

Practice location:
  • Phone: 408-378-6131
  • Fax:
Mailing address:
  • Phone: 510-350-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA96933
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA96933
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: