Provider Demographics
NPI:1285825158
Name:CHRISTIAN, WILLIAM KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KENNETH
Last Name:CHRISTIAN
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2001 SANTA MONICA BLVD STE 985W
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2155
Mailing Address - Country:US
Mailing Address - Phone:310-828-5888
Mailing Address - Fax:310-829-1720
Practice Address - Street 1:2001 SANTA MONICA BLVD STE 985W
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2155
Practice Address - Country:US
Practice Address - Phone:310-828-5888
Practice Address - Fax:310-829-1720
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100485207W00000X, 207WX0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A1004850OtherBLUE SHIELD
CAWA100485AMedicare PIN