Basic Information
| Provider Information | |||||||||
| NPI: | 1306906151 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAMINSKI | ||||||||
| FirstName: | ARTHUR | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 PALOMA AVE | ||||||||
| Address2: | #36 | ||||||||
| City: | VENICE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902918711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153414451 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1300 N VERMONT AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900276005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3239134892 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 10/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 2019042325 | MO | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | A82482 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 01056932A | IN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 036142477 | IL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A824820 | 05 | CA | MEDICAID |