Healthcare Provider Details

I. General information

NPI: 1770775629
Provider Name (Legal Business Name): CHRISTINE CHANNING FRYKMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E 5TH ST
LOS ANGELES CA
90013-1505
US

IV. Provider business mailing address

6148 SAN VICENTE BLVD
LOS ANGELES CA
90048-5414
US

V. Phone/Fax

Practice location:
  • Phone: 213-893-1960
  • Fax:
Mailing address:
  • Phone: 323-937-4833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC52559
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: