Provider Demographics
NPI:1750526265
Name:KUSHNIR, VITALY A (MD)
Entity type:Individual
Prefix:DR
First Name:VITALY
Middle Name:A
Last Name:KUSHNIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11160 WARNER AVE STE 411
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4056
Mailing Address - Country:US
Mailing Address - Phone:714-513-1399
Mailing Address - Fax:714-513-1393
Practice Address - Street 1:11160 WARNER AVE STE 411
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4056
Practice Address - Country:US
Practice Address - Phone:714-513-1399
Practice Address - Fax:714-513-1393
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY265461207VE0102X
CA134759207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty