Healthcare Provider Details

I. General information

NPI: 1841617420
Provider Name (Legal Business Name): KRISTEN LEW M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6109 W.RAMSEY STREET
BANNING CA
92220
US

IV. Provider business mailing address

993 N BROADWAY
LOS ANGELES CA
90012-1763
US

V. Phone/Fax

Practice location:
  • Phone: 951-845-0313
  • Fax:
Mailing address:
  • Phone: 213-625-7995
  • Fax: 213-615-7995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA128750
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA128750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: