Provider Demographics
NPI:1013111608
Name:ADAMS, CRYSTAL LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:LYNN
Last Name:ADAMS
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 1:2020 ZONAL AVE
Mailing Address - Street 2:IRD 220
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033
Mailing Address - Country:US
Mailing Address - Phone:323-409-3423
Mailing Address - Fax:323-409-3509
Practice Address - Street 1:2020 ZONAL AVENUE
Practice Address - Street 2:IRD 220
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-226-3423
Practice Address - Fax:323-226-3509
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR-51192207V00000X, 207V00000X
CAC140466207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO78538564Medicaid
CO78538564Medicaid
WAP00896544OtherRAILROAD MEDICARE
WA8893509Medicare PIN
COCOA107751Medicare PIN