Provider Demographics
NPI:1336201995
Name:KONDRASHOV, DIMITRIY G (MD)
Entity Type:Individual
Prefix:DR
First Name:DIMITRIY
Middle Name:G
Last Name:KONDRASHOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SHRADER ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1016
Mailing Address - Country:US
Mailing Address - Phone:415-221-0665
Mailing Address - Fax:415-221-0687
Practice Address - Street 1:1 SHRADER ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1036
Practice Address - Country:US
Practice Address - Phone:415-221-0665
Practice Address - Fax:415-221-0687
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92439207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI33200Medicare UPIN
CAZZZ48419ZMedicare PIN