Provider Demographics
NPI:1720436918
Name:CHRISTOPHER J WOODSON MD
Entity Type:Organization
Organization Name:CHRISTOPHER J WOODSON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOODSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-206-0177
Mailing Address - Street 1:3851 KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3309
Mailing Address - Country:US
Mailing Address - Phone:562-206-0177
Mailing Address - Fax:562-206-1576
Practice Address - Street 1:3851 KATELLA AVE
Practice Address - Street 2:# 375
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3309
Practice Address - Country:US
Practice Address - Phone:562-206-0177
Practice Address - Fax:562-206-1576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80613207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1588861488OtherINDIVIDUAL NPI