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NPI Code Detail

MEDICARE: IRINA KIMYAGAROVA DO

MEDICARE: IRINA KIMYAGAROVA DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician222382-1NY

General Provider Information

NPI Number : 1275776650
Entity Type Code : Individual
Provider Name (Legal Business Name) : IRINA KIMYAGAROVA DO
Provider Business Mailing Address
First Line : 9424 63RD DR
Second Line :
City : REGO PARK
State : NY
Zip : 11374-2028
Country : US
Telephone Number : 917-977-1107
Fax Number :
Provider Business Practice Location Address
First Line : 9424 63RD DR
Second Line :
City : REGO PARK
State : NY
Zip : 11374-2028
Country : US
Telephone Number : 917-977-1107
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2009
Last Update Date : 04/14/2009

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