Provider Demographics
NPI:1699732636
Name:KINO, RUSS (MD)
Entity type:Individual
Prefix:
First Name:RUSS
Middle Name:
Last Name:KINO
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:PO BOX 12079
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92685-3852
Mailing Address - Country:US
Mailing Address - Phone:562-809-3595
Mailing Address - Fax:562-468-0347
Practice Address - Street 1:1328 22ND STREET
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2091
Practice Address - Country:US
Practice Address - Phone:310-582-7089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48071207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A480710Medicaid
CA00A480710Medicaid
CAWA48071BMedicare PIN