Healthcare Provider Details

I. General information

NPI: 1528590536
Provider Name (Legal Business Name): AARON KRUG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 FAIRMOUNT AVE STE 412
PASADENA CA
91105-3154
US

IV. Provider business mailing address

800 S FAIRMOUNT AVE STE 412
PASADENA CA
91105
US

V. Phone/Fax

Practice location:
  • Phone: 265-440-3006
  • Fax: 214-987-1845
Mailing address:
  • Phone: 626-544-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA158115
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: