Provider Demographics
NPI:1205424843
Name:KINNAIRD ANESTHESIA AND PAIN, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:KINNAIRD ANESTHESIA AND PAIN, A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:CHANG
Authorized Official - Last Name:KINNAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-369-8115
Mailing Address - Street 1:3555 ROSECRANS ST STE 114-531
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3231
Mailing Address - Country:US
Mailing Address - Phone:619-369-8115
Mailing Address - Fax:619-215-0807
Practice Address - Street 1:4060 FOURTH AVE STE 510
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2121
Practice Address - Country:US
Practice Address - Phone:619-369-8115
Practice Address - Fax:619-326-3958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-08
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty