Healthcare Provider Details

I. General information

NPI: 1497887913
Provider Name (Legal Business Name): JACK KRIEGSMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2007
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 MCCONNELL DR
LOS ANGELES CA
90064-4640
US

IV. Provider business mailing address

3010 MCCONNELL DR
LOS ANGELES CA
90064-4640
US

V. Phone/Fax

Practice location:
  • Phone: 310-836-2848
  • Fax: 310-836-2828
Mailing address:
  • Phone: 310-836-2848
  • Fax: 310-836-2828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberAFE19453
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: