Provider Demographics
NPI:1912134552
Name:MOLSTROM, CHRISTIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:
Last Name:MOLSTROM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 NE 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3452
Mailing Address - Country:US
Mailing Address - Phone:503-757-5779
Mailing Address - Fax:
Practice Address - Street 1:1310 EL CAMINO REAL STE J
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-1305
Practice Address - Country:US
Practice Address - Phone:650-270-2395
Practice Address - Fax:650-270-2397
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD157220207P00000X
CAC170858207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine