Healthcare Provider Details

I. General information

NPI: 1265463970
Provider Name (Legal Business Name): VIJAY KINI MD. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 04/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2895 EDINGER AVE
TUSTIN CA
92780-7257
US

IV. Provider business mailing address

PO BOX 101455
PASADENA CA
91189-1455
US

V. Phone/Fax

Practice location:
  • Phone: 949-381-5800
  • Fax: 949-552-5152
Mailing address:
  • Phone: 770-693-2622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: VIJAYKUMAR R KINI
Title or Position: OWNER
Credential: MD
Phone: 949-381-5800