Provider Demographics
NPI:1790877058
Name:CHRISTOPHER K. TINER MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CHRISTOPHER K. TINER MEDICAL CORPORATION
Other - Org Name:CHRISTOPHER K. TINER, MD INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:K
Authorized Official - Last Name:TINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-788-9152
Mailing Address - Street 1:50 BELLEFONTAINE ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3132
Mailing Address - Country:US
Mailing Address - Phone:626-788-9152
Mailing Address - Fax:626-658-8917
Practice Address - Street 1:50 BELLEFONTAINE ST
Practice Address - Street 2:SUITE 304
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3132
Practice Address - Country:US
Practice Address - Phone:626-788-9152
Practice Address - Fax:626-658-8917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87203174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20044Medicare PIN