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General NPI Number Information
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NPI Number | 1891993150
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Entity Type | Individual
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Provider Name | DAVID WILLIAM KRUSE MD
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Gender | Male
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 2400 E KATELLA AVE STE 400
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City | ANAHEIM
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State | CA
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Zip | 92806-5972
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Country | US
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Telephone | 310-423-4566
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Fax | 310-423-9958
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Provider Business Mailing Address
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Address Line | 444 S SAN VICENTE BLVD STE 603
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City | LOS ANGELES
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State | CA
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Zip | 90048-4178
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Country | US
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Telephone | 310-423-4566
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | A92859
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License Number State | CA
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