Healthcare Provider Details

I. General information

NPI: 1467741983
Provider Name (Legal Business Name): DAVID S KRAMER MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3356 W BALL RD 206
ANAHEIM CA
92804-3702
US

IV. Provider business mailing address

6575 CHURCHILL DR
HUNTINGTON BEACH CA
92648-1513
US

V. Phone/Fax

Practice location:
  • Phone: 714-827-8890
  • Fax: 714-827-8905
Mailing address:
  • Phone: 714-827-8890
  • Fax: 714-827-8905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG49359
License Number StateCA

VIII. Authorized Official

Name: GINGER IRENE WATTS
Title or Position: MEDICAL BILLER
Credential:
Phone: 714-827-8890