Provider Demographics
NPI:1639747652
Name:KASPAROV, DMITRY
Entity Type:Individual
Prefix:MR
First Name:DMITRY
Middle Name:
Last Name:KASPAROV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 CABRILLO ST APT 6
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-3732
Mailing Address - Country:US
Mailing Address - Phone:415-359-3060
Mailing Address - Fax:
Practice Address - Street 1:2045 CABRILLO ST APT 6
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-3732
Practice Address - Country:US
Practice Address - Phone:415-359-3060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)