MEDICARE: KRISTIN EILEEN KEA ANDRADE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	A89016	CA
2	208000000X	Pediatrics Physician	MD-14035	HI

General Provider Information

NPI Number	:	1184774580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN EILEEN KEA ANDRADE M.D.

Provider Business Mailing Address
First Line	:	19431 NEWHOUSE ST
Second Line	:
City	:	CANYON COUNTRY
State	:	CA
Zip	:	91351-2783
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1240 N MISSION RD
Second Line	:	ROOM L-902
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1019
Country	:	US
Telephone Number	:	323-226-3691
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2007

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