Healthcare Provider Details

I. General information

NPI: 1114131489
Provider Name (Legal Business Name): KRISTOPHER LYON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 MADONNA RD STE B
SAN LUIS OBISPO CA
93405-5432
US

IV. Provider business mailing address

283 MADONNA RD STE B
SAN LUIS OBISPO CA
93405-5432
US

V. Phone/Fax

Practice location:
  • Phone: 805-549-8880
  • Fax: 805-783-2009
Mailing address:
  • Phone: 805-549-8880
  • Fax: 805-783-2009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberA100746
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA100746
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: