MEDICARE: DR. KRISTINA TANSAVATDI 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	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	A116470	CA
2	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	A116470	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1336497353	OTHER		NPI

General Provider Information

NPI Number	:	1932397007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTINA TANSAVATDI M.D.

Provider Business Mailing Address
First Line	:	2835 TOWNSGATE RD STE 100
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-5021
Country	:	US
Telephone Number	:	805-715-4996
Fax Number	:	805-715-4995

Provider Business Practice Location Address
First Line	:	2835 TOWNSGATE RD STE 100
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-5021
Country	:	US
Telephone Number	:	805-715-4996
Fax Number	:	805-715-4995

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

Provider Enumeration Date	:	10/13/2007
Last Update Date	:	03/03/2024

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