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General NPI Number Information
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NPI Number | 1821076852
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Entity Type | Individual
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Provider Name | ILYA KAMINSKY RPT, DC
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Gender | Male
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Dates
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Enumeration Date | 01/09/2006
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Last Update Date | 05/18/2009
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Provider Practice Location Address
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Address Line | 6333 WILSHIRE BLVD 101
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City | LOS ANGELES
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State | CA
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Zip | 90048-5702
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Country | US
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Telephone | 323-966-2676
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Fax | 323-966-2677
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Provider Business Mailing Address
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Address Line | 2321 ACHILLES DR
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City | LOS ANGELES
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State | CA
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Zip | 90046-1623
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Country | US
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Telephone | 323-966-2676
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Fax | 323-966-2677
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT19092
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC25455
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License Number State | CA
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