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General NPI Number Information
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NPI Number | 1881897494
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Entity Type | Individual
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Provider Name | TIMOTHY S KRISTEDJA MD
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Gender | Male
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Dates
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Enumeration Date | 06/09/2007
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 2001 SANTA MONICA BLVD STE 560W
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City | SANTA MONICA
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State | CA
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Zip | 90404-2182
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Country | US
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Telephone | 310-453-5654
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Fax | 310-453-6885
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Provider Business Mailing Address
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Address Line | 2477 WALNUT AVE
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City | VENICE
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State | CA
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Zip | 90291-5018
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Country | US
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Telephone | 626-367-2824
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | A108522
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License Number State | CA
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