Provider Demographics
NPI:1831171842
Name:KANE, BRYNA PEARL (MD)
Entity type:Individual
Prefix:MRS
First Name:BRYNA
Middle Name:PEARL
Last Name:KANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3828 SCHAUFELE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1793
Mailing Address - Country:US
Mailing Address - Phone:562-997-1144
Mailing Address - Fax:562-989-3612
Practice Address - Street 1:3828 SCHAUFELE AVE STE 300
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1793
Practice Address - Country:US
Practice Address - Phone:562-997-1144
Practice Address - Fax:562-989-3612
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37025174400000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84951Medicare UPIN
CAWA37025EMedicare PIN
CAW14250Medicare ID - Type UnspecifiedMEDICARE PROVIDER#
CA954617601Medicare ID - Type UnspecifiedTAX ID#