Healthcare Provider Details

I. General information

NPI: 1558703363
Provider Name (Legal Business Name): KRISZTINA ILONA LARSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 S BUENA VISTA ST FL 4
BURBANK CA
91505-4504
US

IV. Provider business mailing address

541 W COLORADO ST STE 205
GLENDALE CA
91204-3640
US

V. Phone/Fax

Practice location:
  • Phone: 818-840-0921
  • Fax: 818-840-7064
Mailing address:
  • Phone: 323-254-0046
  • Fax: 323-488-9782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA158003
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: