=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548448921
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KRYGER INSITUTE OF PLASTIC SURGERY, A MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2008
-----------------------------------------------------
Last Update Date | 05/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 425 HAALAND DR SUITE 102
-----------------------------------------------------
City | THOUSAND OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91361-5229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-777-3877
-----------------------------------------------------
Fax | 818-888-0904
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 425 HAALAND DRIVE SUITE 102
-----------------------------------------------------
City | THOUSAND OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-777-3877
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ZOL KRYGER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 805-777-3877
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------