Provider Demographics
NPI:1649354309
Name:KINI, DIVYA R (MD)
Entity type:Individual
Prefix:
First Name:DIVYA
Middle Name:R
Last Name:KINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1500 SOUTHGATE AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015
Mailing Address - Country:US
Mailing Address - Phone:650-755-2192
Mailing Address - Fax:650-745-0710
Practice Address - Street 1:1500 SOUTHGATE AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015
Practice Address - Country:US
Practice Address - Phone:650-755-2192
Practice Address - Fax:650-745-0710
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2015-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA74472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H44386Medicare UPIN
CA00A744720Medicare ID - Type Unspecified