Healthcare Provider Details

I. General information

NPI: 1386860997
Provider Name (Legal Business Name): MARIYA DMYTRIV-KAPENIAK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIYA DMYTRIV MD

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 N DAMEN AVE
CHICAGO IL
60647-5553
US

IV. Provider business mailing address

1 EMBARCADERO CTR STE 1900
SAN FRANCISCO CA
94111-3723
US

V. Phone/Fax

Practice location:
  • Phone: 312-219-2230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC211159
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number036120196
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: