Healthcare Provider Details

I. General information

NPI: 1992931190
Provider Name (Legal Business Name): TYLER DUSTIN KROHN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 AVENUE OF THE STARS SUITE 3800
LOS ANGELES CA
90067-6022
US

IV. Provider business mailing address

1999 AVENUE OF THE STARS SUITE 3800
LOS ANGELES CA
90067-6022
US

V. Phone/Fax

Practice location:
  • Phone: 310-229-3133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA106309
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: