Healthcare Provider Details

I. General information

NPI: 1821115825
Provider Name (Legal Business Name): KRISTI MARI FUNK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTI MARI PADO M.D.

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 11/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 WILSHIRE BLVD STE 300
BEVERLY HILLS CA
90211-1959
US

IV. Provider business mailing address

8900 WILSHIRE BLVD STE 300
BEVERLY HILLS CA
90211-1959
US

V. Phone/Fax

Practice location:
  • Phone: 310-273-8002
  • Fax: 310-273-8608
Mailing address:
  • Phone: 310-273-8002
  • Fax: 310-273-8608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberA73916
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: