1003010950 NPI number — DR. KRISTINE SUZANNE OLSON ARTHUR MD

Table of content: DR. KRISTINE SUZANNE OLSON ARTHUR MD (NPI 1003010950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003010950 NPI number — DR. KRISTINE SUZANNE OLSON ARTHUR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARTHUR
Provider First Name:
KRISTINE
Provider Middle Name:
SUZANNE OLSON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OLSON
Provider Other First Name:
KRISTINE
Provider Other Middle Name:
SUZANNE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003010950
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2742 DOW AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUSTIN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92780-7242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-665-1600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11420 WARNER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOUNTAIN VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92708-2529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-549-1300
Provider Business Practice Location Address Fax Number:
714-433-3100
Provider Enumeration Date:
06/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A95013 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A950130 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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