Provider Demographics
NPI:1326088618
Name:FINK, STEVEN JAY (PA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JAY
Last Name:FINK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 DE SOTO AVE
Mailing Address - Street 2:321
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-3761
Mailing Address - Country:US
Mailing Address - Phone:818-800-4886
Mailing Address - Fax:
Practice Address - Street 1:6100 DE SOTO AVE
Practice Address - Street 2:321
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367
Practice Address - Country:US
Practice Address - Phone:818-800-4886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11749363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA11749Medicaid
CA970018041Medicare PIN
CAWPA11749CMedicare PIN
CAPA11749Medicaid
CAWPA11749EMedicare PIN