Provider Demographics
NPI:1225226228
Name:CHRISTOPHER J KRPAN DO PSC
Entity Type:Organization
Organization Name:CHRISTOPHER J KRPAN DO PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:KRPAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:209-736-1147
Mailing Address - Street 1:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:1300 KURT DR
Practice Address - Street 2:SUITE 105
Practice Address - City:ANGELS CAMP
Practice Address - State:CA
Practice Address - Zip Code:95222-9324
Practice Address - Country:US
Practice Address - Phone:209-736-1147
Practice Address - Fax:209-736-8094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7650207X00000X
CA5209930001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX76500Medicaid
CAZZZ29860ZMedicare PIN
CACH406AMedicare PIN
CAH36655Medicare UPIN
CA5209930001Medicare NSC