Provider Demographics
NPI:1427168772
Name:KAMINSKI, CHICHUAN Y (MD)
Entity type:Individual
Prefix:
First Name:CHICHUAN
Middle Name:Y
Last Name:KAMINSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6521 WINNEPEG RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1607
Mailing Address - Country:US
Mailing Address - Phone:301-530-5285
Mailing Address - Fax:
Practice Address - Street 1:6521 WINNEPEG RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1607
Practice Address - Country:US
Practice Address - Phone:301-530-5285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0537662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG53766Medicaid
GA30BDLQQMedicare ID - Type UnspecifiedGA MEDICARE
I08102Medicare UPIN