Provider Demographics
NPI:1992061923
Name:YAROSLAV KUSHNIR M.D., INC
Entity type:Organization
Organization Name:YAROSLAV KUSHNIR M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YAROSLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSHNIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-585-3000
Mailing Address - Street 1:709 THIRD AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5803
Mailing Address - Country:US
Mailing Address - Phone:619-585-3000
Mailing Address - Fax:619-585-3002
Practice Address - Street 1:709 THIRD AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5803
Practice Address - Country:US
Practice Address - Phone:619-585-3000
Practice Address - Fax:619-585-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG242382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G242380Medicaid
CAC35942Medicare UPIN