Provider Demographics
NPI:1790701225
Name:WINGFIELD WILLIAMS, KRISTIN A (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:A
Last Name:WINGFIELD WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:304 TODD WAY
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-3442
Mailing Address - Country:US
Mailing Address - Phone:650-804-2252
Mailing Address - Fax:415-727-9841
Practice Address - Street 1:20 SUNNYSIDE AVE STE B
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1928
Practice Address - Country:US
Practice Address - Phone:415-322-0230
Practice Address - Fax:415-727-9841
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA83480207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI17029Medicare UPIN
CA00A834800Medicare ID - Type Unspecified