Healthcare Provider Details

I. General information

NPI: 1093787822
Provider Name (Legal Business Name): KRISTIN CHAPMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 E CALIFORNIA BLVD SUITE 200
PASADENA CA
91105-3954
US

IV. Provider business mailing address

145 VISTA AVE SUITE 104
PASADENA CA
91107-3607
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-7350
  • Fax: 626-449-1321
Mailing address:
  • Phone: 626-397-8335
  • Fax: 626-397-8350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA73205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: