Provider Demographics
NPI:1336371285
Name:FLEMING, KRISTY FAYE (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:FAYE
Last Name:FLEMING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTY
Other - Middle Name:FAYE
Other - Last Name:HINCHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 6765
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-6765
Mailing Address - Country:US
Mailing Address - Phone:714-571-5000
Mailing Address - Fax:714-571-5055
Practice Address - Street 1:180 NEWPORT CENTER DR
Practice Address - Street 2:SUITE 158
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-6972
Practice Address - Country:US
Practice Address - Phone:949-719-1800
Practice Address - Fax:949-719-1810
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10034283207N00000X
CAA120835207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB250879Medicare PIN
CACB257517Medicare UPIN