Provider Demographics
NPI:1710126974
Name:GOLDSMITH, KRISTOPHER (LAC)
Entity Type:Individual
Prefix:MR
First Name:KRISTOPHER
Middle Name:
Last Name:GOLDSMITH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6336 WILSHIRE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5002
Mailing Address - Country:US
Mailing Address - Phone:323-951-9500
Mailing Address - Fax:
Practice Address - Street 1:6336 WILSHIRE BLVD STE B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5002
Practice Address - Country:US
Practice Address - Phone:323-951-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11427171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist