Healthcare Provider Details

I. General information

NPI: 1861580599
Provider Name (Legal Business Name): MICHAEL GENE KINNISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 VETERANS MEMORIAL CIRCLE
YUBA CITY CA
95993
US

IV. Provider business mailing address

750 LINCOLN RD APT 23
YUBA CITY CA
95991-6600
US

V. Phone/Fax

Practice location:
  • Phone: 530-822-7215
  • Fax:
Mailing address:
  • Phone: 530-673-8067
  • Fax: 530-822-7223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG40769
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: