Provider Demographics
NPI:1083838627
Name:BANNYKH, GALINA IVANOVNA (MD)
Entity Type:Individual
Prefix:MRS
First Name:GALINA
Middle Name:IVANOVNA
Last Name:BANNYKH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GALINA
Other - Middle Name:
Other - Last Name:CHEMYANOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22 SUNRISE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-3720
Mailing Address - Country:US
Mailing Address - Phone:619-528-3430
Mailing Address - Fax:
Practice Address - Street 1:4647 ZION AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-2507
Practice Address - Country:US
Practice Address - Phone:619-528-3430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76585207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology