Provider Demographics
NPI:1023246089
Name:KUSHNARYOV, ANTON (MD)
Entity type:Individual
Prefix:
First Name:ANTON
Middle Name:
Last Name:KUSHNARYOV
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 1:3909 WARING RD STE A
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4455
Mailing Address - Country:US
Mailing Address - Phone:760-726-2440
Mailing Address - Fax:760-726-0644
Practice Address - Street 1:3909 WARING RD STE A
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4455
Practice Address - Country:US
Practice Address - Phone:760-726-2440
Practice Address - Fax:760-726-0644
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA114550207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology