Provider Demographics
NPI:1184750861
Name:HALLSTEN, KATHRYN JOANNE (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:JOANNE
Last Name:HALLSTEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:JOANNE
Other - Last Name:HALLSTEN RITCHEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1156 RAMONA ST
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2445
Mailing Address - Country:US
Mailing Address - Phone:650-325-9906
Mailing Address - Fax:650-325-1295
Practice Address - Street 1:130 PORTOLA RD
Practice Address - Street 2:SUITE C
Practice Address - City:PORTOLA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94028-7825
Practice Address - Country:US
Practice Address - Phone:650-385-1970
Practice Address - Fax:650-851-9701
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60511207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine