Healthcare Provider Details

I. General information

NPI: 1366766792
Provider Name (Legal Business Name): GIL KRYGER MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2010
Last Update Date: 03/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 HAALAND DR SUITE 102
THOUSAND OAKS CA
91361-5229
US

IV. Provider business mailing address

425 HAALAND DR SUITE 102
THOUSAND OAKS CA
91361-5229
US

V. Phone/Fax

Practice location:
  • Phone: 805-777-3877
  • Fax: 805-777-4822
Mailing address:
  • Phone: 805-777-3877
  • Fax: 805-777-4822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA80982
License Number StateCA

VIII. Authorized Official

Name: GIL KRYGER
Title or Position: PRESIDENT
Credential: MD
Phone: 805-777-3877