Provider Demographics
NPI:1265463970
Name:VIJAY KINI MD. INC.
Entity Type:Organization
Organization Name:VIJAY KINI MD. INC.
Other - Org Name:RADIATION ONCOLOGY MEDICAL GROUP OF SOUTHERN CA, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIJAYKUMAR
Authorized Official - Middle Name:R
Authorized Official - Last Name:KINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-381-5800
Mailing Address - Street 1:PO BOX 101455
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91189-1455
Mailing Address - Country:US
Mailing Address - Phone:770-693-2622
Mailing Address - Fax:
Practice Address - Street 1:2895 EDINGER AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7257
Practice Address - Country:US
Practice Address - Phone:949-381-5800
Practice Address - Fax:949-552-5152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ77835ZMedicaid
CAZZZ77835ZMedicaid
CAW19364Medicare ID - Type Unspecified