Provider Demographics
NPI:1780261040
Name:HANCOCK, KRISTEN (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 FERNDALE PL
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-2348
Mailing Address - Country:US
Mailing Address - Phone:310-944-0851
Mailing Address - Fax:
Practice Address - Street 1:1411 E 31ST ST # 22123
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1092
Practice Address - Country:US
Practice Address - Phone:510-437-4564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program