Provider Demographics
NPI:1750761656
Name:ALINA KAGAN OD, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ALINA KAGAN OD, A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:650-654-2015
Mailing Address - Street 1:1601 EL CAMINO REAL
Mailing Address - Street 2:STE 302
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-3948
Mailing Address - Country:US
Mailing Address - Phone:650-654-2015
Mailing Address - Fax:650-654-2014
Practice Address - Street 1:1601 EL CAMINO REAL
Practice Address - Street 2:STE 302
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-3948
Practice Address - Country:US
Practice Address - Phone:650-654-2015
Practice Address - Fax:650-654-2014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11666T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty