Provider Demographics
NPI:1154989150
Name:TROFIMOV, KIRILL
Entity type:Individual
Prefix:DR
First Name:KIRILL
Middle Name:
Last Name:TROFIMOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15725 POMERADO RD STE 204
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2059
Mailing Address - Country:US
Mailing Address - Phone:858-485-8420
Mailing Address - Fax:
Practice Address - Street 1:15725 POMERADO RD STE 204
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2059
Practice Address - Country:US
Practice Address - Phone:858-485-8420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1037351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice