Provider Demographics
NPI:1013946565
Name:KRIEGER, DAVID ELLIOTT (MD,PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ELLIOTT
Last Name:KRIEGER
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25775 MCBEAN PKWY
Mailing Address - Street 2:SUITE 115
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-3708
Mailing Address - Country:US
Mailing Address - Phone:661-255-2420
Mailing Address - Fax:661-259-5741
Practice Address - Street 1:25775 MCBEAN PKWY
Practice Address - Street 2:SUITE 115
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-3708
Practice Address - Country:US
Practice Address - Phone:661-255-2420
Practice Address - Fax:661-259-5741
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTG42146207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WG42146BMedicare PIN
CAWG42146AMedicare PIN
CAA48834Medicare UPIN