Provider Demographics
NPI:1134889710
Name:KAM, KRISTINA ANN
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:ANN
Last Name:KAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3927 BARRYKNOLL DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-4305
Mailing Address - Country:US
Mailing Address - Phone:808-428-5158
Mailing Address - Fax:
Practice Address - Street 1:1234 N LA BREA AVE
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90038
Practice Address - Country:US
Practice Address - Phone:909-293-8515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-23
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT301281225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist