Provider Demographics
NPI:1841208402
Name:WALKER, KRISTIN K (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:K
Last Name:WALKER
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 1:89 DAVIS RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-3031
Mailing Address - Country:US
Mailing Address - Phone:925-254-1080
Mailing Address - Fax:925-254-1652
Practice Address - Street 1:89 DAVIS RD
Practice Address - Street 2:SUITE 180
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-3031
Practice Address - Country:US
Practice Address - Phone:925-254-1080
Practice Address - Fax:925-254-1652
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG078292207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G782920Medicare ID - Type Unspecified
G38765Medicare UPIN