Provider Demographics
NPI:1568677607
Name:CHRISTOPHER R. LUNDQUIST M.D
Entity Type:Organization
Organization Name:CHRISTOPHER R. LUNDQUIST M.D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PRACTICE M.D.
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:REED
Authorized Official - Last Name:LUNDQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-579-7505
Mailing Address - Street 1:2874 E IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-6714
Mailing Address - Country:US
Mailing Address - Phone:714-579-7505
Mailing Address - Fax:714-993-4130
Practice Address - Street 1:2874 E IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-6714
Practice Address - Country:US
Practice Address - Phone:714-579-7505
Practice Address - Fax:714-993-4130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOOG45191174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG45191Medicare PIN