Provider Demographics
NPI:1982166237
Name:WI, KRISTIANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIANNA
Middle Name:
Last Name:WI
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 1:30075 TRIUNFO DR
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-3028
Mailing Address - Country:US
Mailing Address - Phone:818-309-6326
Mailing Address - Fax:
Practice Address - Street 1:333 CITY BLVD W STE 2150
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-5920
Practice Address - Country:US
Practice Address - Phone:714-456-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA180952207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology