Provider Demographics
NPI:1689875692
Name:KUSHNIR, NATALIYA M (MD)
Entity Type:Individual
Prefix:
First Name:NATALIYA
Middle Name:M
Last Name:KUSHNIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 WOOLSEY ST 314
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1976
Mailing Address - Country:US
Mailing Address - Phone:925-270-5119
Mailing Address - Fax:510-666-0916
Practice Address - Street 1:2320 WOOLSEY ST 314
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1976
Practice Address - Country:US
Practice Address - Phone:925-270-5119
Practice Address - Fax:510-666-0916
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA83416207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA83416OtherCA STATE LICENSE