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NPI Code Detail

MEDICARE: TIMOTHY S KRISTEDJA MD

MEDICARE: TIMOTHY S KRISTEDJA MD
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
1207RH0003XHematology & Oncology PhysicianA108522CA

General Provider Information

NPI Number : 1881897494
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY S KRISTEDJA MD
Provider Business Mailing Address
First Line : 2477 WALNUT AVE
Second Line :
City : VENICE
State : CA
Zip : 90291-5018
Country : US
Telephone Number : 626-367-2824
Fax Number :
Provider Business Practice Location Address
First Line : 2001 SANTA MONICA BLVD STE 560W
Second Line :
City : SANTA MONICA
State : CA
Zip : 90404-2182
Country : US
Telephone Number : 310-453-5654
Fax Number : 310-453-6885
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2007
Last Update Date : 01/22/2024

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Directions to “ TIMOTHY S KRISTEDJA MD” Practice Location

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