Provider Demographics
NPI:1831100080
Name:NIELSEN, KRISTIN A (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:A
Last Name:NIELSEN
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 1:170 ALAMEDA DE LAS PULGAS
Mailing Address - Street 2:HOSPITALIST OFFICE
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-2751
Mailing Address - Country:US
Mailing Address - Phone:650-367-5659
Mailing Address - Fax:650-482-6163
Practice Address - Street 1:170 ALAMEDA DE LAS PULGAS
Practice Address - Street 2:HOSPITALIST OFFICE
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-2751
Practice Address - Country:US
Practice Address - Phone:650-367-5659
Practice Address - Fax:650-482-6163
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71354207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH50792Medicare UPIN
CAWA71354AMedicare ID - Type UnspecifiedPPIN #