Provider Demographics
NPI:1518970235
Name:PETERSON, KAREN LINNEA (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LINNEA
Last Name:PETERSON
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 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:960 E GREEN ST STE 208
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2401
Practice Address - Country:US
Practice Address - Phone:424-314-0196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036232207Y00000X
CAA53128207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8230948Medicaid
040014303OtherRAILROAD MEDICARE
WA0039572OtherLABOR & INDUSTRY
WAMD5018WOtherALASKA MEDICAID
WAPE3331OtherBLUE SHIELD
WAUS1037408OtherAETNA/USHC SPECIALIST
WA8850246Medicare PIN
WAUS1037408OtherAETNA/USHC SPECIALIST