Provider Demographics
NPI:1396829511
Name:KAMINSKY, LAWRENCE (DPM)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:KAMINSKY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24310 MOULTON PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-3306
Mailing Address - Country:US
Mailing Address - Phone:949-855-4414
Mailing Address - Fax:949-855-1209
Practice Address - Street 1:24310 MOULTON PKWY STE A
Practice Address - Street 2:
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-3306
Practice Address - Country:US
Practice Address - Phone:949-855-4414
Practice Address - Fax:949-855-1209
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2543213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE2543Medicare PIN
4954620001Medicare NSC
CAT11375Medicare UPIN