Provider Demographics
NPI:1386657195
Name:RICHARDS, KRISTEN ANNE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ANNE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9850 GENESEE AVE STE 460
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1228
Mailing Address - Country:US
Mailing Address - Phone:858-362-8800
Mailing Address - Fax:858-362-8803
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:SUITE 460
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1228
Practice Address - Country:US
Practice Address - Phone:858-362-8800
Practice Address - Fax:858-362-8803
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74648207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA74648OtherMEDICAL LICENSE
CAH23753Medicare UPIN
CAWA74648AMedicare ID - Type Unspecified