Provider Demographics
NPI:1306011150
Name:DAVID S KRAMER MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DAVID S KRAMER MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-827-8890
Mailing Address - Street 1:6575 CHURCHILL DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1513
Mailing Address - Country:US
Mailing Address - Phone:714-827-8890
Mailing Address - Fax:714-827-8905
Practice Address - Street 1:3356 W BALL RD
Practice Address - Street 2:SUITE 206
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3702
Practice Address - Country:US
Practice Address - Phone:714-827-8890
Practice Address - Fax:714-827-8905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49359207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G493591Medicaid
CAA92896Medicare UPIN