Provider Demographics
NPI:1881897494
Name:KRISTEDJA, TIMOTHY S (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:S
Last Name:KRISTEDJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2477 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-5018
Mailing Address - Country:US
Mailing Address - Phone:626-367-2824
Mailing Address - Fax:
Practice Address - Street 1:2001 SANTA MONICA BLVD STE 560W
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2182
Practice Address - Country:US
Practice Address - Phone:310-453-5654
Practice Address - Fax:310-453-6885
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-09
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA108522207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology