Provider Demographics
NPI:1417128125
Name:ILYA KAMINSKY DC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ILYA KAMINSKY DC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MILANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KALIKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-345-0504
Mailing Address - Street 1:6333 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5702
Mailing Address - Country:US
Mailing Address - Phone:323-966-2676
Mailing Address - Fax:323-966-2677
Practice Address - Street 1:6333 WILSHIRE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5702
Practice Address - Country:US
Practice Address - Phone:323-966-2676
Practice Address - Fax:323-966-2677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19092225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0190920Medicaid
CAPT0190921Medicaid
CAPT0190921Medicaid
CAPT19092AMedicare PIN
CAPT19092Medicare PIN