Provider Demographics
NPI:1730274176
Name:KUSHNIR, YAROSLAV (MD)
Entity type:Individual
Prefix:DR
First Name:YAROSLAV
Middle Name:
Last Name:KUSHNIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 THIRD AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5803
Mailing Address - Country:US
Mailing Address - Phone:619-585-3000
Mailing Address - Fax:619-585-3002
Practice Address - Street 1:709 THIRD AVENUE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5803
Practice Address - Country:US
Practice Address - Phone:619-585-3000
Practice Address - Fax:619-585-3002
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG242382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G242380Medicaid
CA00G242380Medicaid
CAG24238Medicare ID - Type Unspecified