Provider Demographics
NPI:1588718811
Name:KINOTA, STANISLAUS (MD)
Entity type:Individual
Prefix:
First Name:STANISLAUS
Middle Name:
Last Name:KINOTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4727 W 147TH ST APT 218B
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-1310
Mailing Address - Country:US
Mailing Address - Phone:310-978-2863
Mailing Address - Fax:
Practice Address - Street 1:4450 W CENTURY BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90304-1504
Practice Address - Country:US
Practice Address - Phone:310-671-0555
Practice Address - Fax:310-674-5292
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73647208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF43123Medicare UPIN