Provider Demographics
NPI:1760546113
Name:PANIK, KRISTINE
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:PANIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2428 DWIGHT WAY STE 5
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-3503
Mailing Address - Country:US
Mailing Address - Phone:510-845-5155
Mailing Address - Fax:510-845-5155
Practice Address - Street 1:2428 DWIGHT WAY STE 5
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-3503
Practice Address - Country:US
Practice Address - Phone:510-845-5155
Practice Address - Fax:510-845-5155
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA545932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry