Healthcare Provider Details

I. General information

NPI: 1003010950
Provider Name (Legal Business Name): KRISTINE SUZANNE OLSON ARTHUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINE SUZANNE OLSON MD

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11420 WARNER AVE
FOUNTAIN VALLEY CA
92708-2529
US

IV. Provider business mailing address

2742 DOW AVE
TUSTIN CA
92780-7242
US

V. Phone/Fax

Practice location:
  • Phone: 714-549-1300
  • Fax: 714-433-3100
Mailing address:
  • Phone: 714-665-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA95013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: