Provider Demographics
NPI:1417940198
Name:KINI, VIJAYKUMAR RAMCHANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAYKUMAR
Middle Name:RAMCHANDRA
Last Name:KINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 101455
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91189-1455
Mailing Address - Country:US
Mailing Address - Phone:949-381-5800
Mailing Address - Fax:949-552-5152
Practice Address - Street 1:2895 EDINGER AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7257
Practice Address - Country:US
Practice Address - Phone:949-381-5800
Practice Address - Fax:949-552-5152
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA847392085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A847390Medicaid
CAG97770Medicare UPIN
CA00A847390Medicaid