Healthcare Provider Details

I. General information

NPI: 1790701225
Provider Name (Legal Business Name): KRISTIN A WINGFIELD WILLIAMS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 01/05/2025
Certification Date: 01/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 SUNNYSIDE AVE STE B
MILL VALLEY CA
94941-1928
US

IV. Provider business mailing address

304 TODD WAY
MILL VALLEY CA
94941-3442
US

V. Phone/Fax

Practice location:
  • Phone: 415-322-0230
  • Fax: 415-727-9841
Mailing address:
  • Phone: 650-804-2252
  • Fax: 415-727-9841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA83480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: