Healthcare Provider Details

I. General information

NPI: 1659389104
Provider Name (Legal Business Name): KRIS M. BJORNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 06/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PROSPECT PL
CORONADO CA
92118-1943
US

IV. Provider business mailing address

210 N TUSTIN AVE
SANTA ANA CA
92705-3807
US

V. Phone/Fax

Practice location:
  • Phone: 619-522-3600
  • Fax: 714-647-1243
Mailing address:
  • Phone: 714-347-1000
  • Fax: 714-647-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG27581
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: