Provider Demographics
NPI:1326589045
Name:INSTITUTE OF INTEGRATIVE IMMUNOLOGY, INC
Entity Type:Organization
Organization Name:INSTITUTE OF INTEGRATIVE IMMUNOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DMITRIY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUKHOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-984-6500
Mailing Address - Street 1:2320 WOOLSEY ST
Mailing Address - Street 2:SUITE 314
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1973
Mailing Address - Country:US
Mailing Address - Phone:510-984-6500
Mailing Address - Fax:510-666-0916
Practice Address - Street 1:2320 WOOLSEY ST
Practice Address - Street 2:SUITE 314
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1973
Practice Address - Country:US
Practice Address - Phone:510-984-6500
Practice Address - Fax:510-666-0916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83416207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty