Provider Demographics
NPI:1194069534
Name:KAMINISHI, KURTIS SACHIO (MD, MBA)
Entity type:Individual
Prefix:
First Name:KURTIS
Middle Name:SACHIO
Last Name:KAMINISHI
Suffix:
Gender:M
Credentials:MD, MBA
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2010 ZONAL AVE # 1P10
Mailing Address - Street 2:DEPARTMENT OF PSYCHIATRY
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-0121
Mailing Address - Country:US
Mailing Address - Phone:323-226-5555
Mailing Address - Fax:
Practice Address - Street 1:2010 ZONAL AVE # 1P10
Practice Address - Street 2:DEPARTMENT OF PSYCHIATRY
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0121
Practice Address - Country:US
Practice Address - Phone:323-226-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA1236772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry