Provider Demographics
NPI:1265489280
Name:CHARI, KAMINI SHYAM (MD)
Entity Type:Individual
Prefix:MRS
First Name:KAMINI
Middle Name:SHYAM
Last Name:CHARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:315 N 3RD AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1916
Mailing Address - Country:US
Mailing Address - Phone:626-967-4469
Mailing Address - Fax:626-967-4889
Practice Address - Street 1:315 N 3RD AVE STE 301
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1916
Practice Address - Country:US
Practice Address - Phone:626-967-4469
Practice Address - Fax:626-967-4889
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA045225207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE71889Medicare UPIN