Provider Demographics
NPI:1275566085
Name:KINALY, MAE (MD)
Entity Type:Individual
Prefix:
First Name:MAE
Middle Name:
Last Name:KINALY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:22 ODYSSEY
Mailing Address - Street 2:STE 215
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3186
Mailing Address - Country:US
Mailing Address - Phone:949-398-7444
Mailing Address - Fax:949-398-7445
Practice Address - Street 1:22 ODYSSEY
Practice Address - Street 2:STE 215
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3186
Practice Address - Country:US
Practice Address - Phone:949-398-7444
Practice Address - Fax:949-398-7445
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2012-12-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG78251207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG67148Medicare UPIN