=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043647951
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KINERET BISMUT M
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2013
-----------------------------------------------------
Last Update Date | 10/09/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 337 S BEVERLY DR
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-867-4925
-----------------------------------------------------
Fax | 714-594-3442
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 337 S BEVERLY DR
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-867-4925
-----------------------------------------------------
Fax | 714-594-3442
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | M6410125
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------