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Provider Information for 1083800296

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DMITRY G AMINOV

Gender: MALE

Individual NPI: 1083800296

Calendar   Last Updated:  2015-11-05
  Certification Date: 

Details

Name Value
NPI 1083800296
Enumeration Date 2007-09-20
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 2780 TAPO CANYON RD A1B
SIMI VALLEY, CA 93063-6837
United States

Phone: 805-520-1711 | Fax: 805-520-1511
View Map External Link
Primary Practice Address 2780 TAPO CANYON RD A-1B
SIMI VALLEY, CA 93063-6840
United States

Phone: 805-520-1711 | Fax: 805-520-1511
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist CA 55889