Timothy S Kristedja
Internal Medicine (Hematology & Oncology)

Address: 2021 Santa Monica Blvd Ste 400e, Santa Monica, CA 90404-2103
Phone: 3104535654

Timothy S Kristedja (NPI# 1881897494) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider Identifier (NPI) 1881897494
Entity Type Individual
Full Name Timothy S Kristedja
Credential MD
Gender Male
Practice Address 2021 Santa Monica Blvd Ste 400e
Santa Monica
CA 90404-2103
Practice Telephone 3104535654
Practice Fax Number 3104536885
Mailing Address 2477 Walnut Ave
Venice
CA 90291-5018
Mailing Telephone 6263672824
Sole Proprietor Yes, this individual is a Sole Proprietor
Enumeration Date 2007-06-09
Last Update Date 2019-01-09

Taxonomy Codes

Primary Taxonomy Classification Taxonomy Group License Number State
Yes 207RH0003X Internal Medicine · Hematology & Oncology Allopathic & Osteopathic Physicians A108522 CA

Physician Overview

NPI 1881897494
PAC ID by PECOS 0840447942
Professional Enrollment ID I20120824000220
Full Name Timothy S Kristedja
Organization Legal Name SAINT JOHN'S HEALTH CLINIC
Phone Number 3102812024
Gender M
Graduation Year 2006
Primary Specialty HEMATOLOGY/ONCOLOGY
Group Practice PAC ID 6800060849
Number of Group Practice Members 117
Accepts Medicare Assignment Y
Report Quality Measures Y
Use Electronic Health Records Y

Claims Based Hospital Affiliation

Claim Control Number (CCN) Legal Business Name
050290 PROVIDENCE SAINT JOHN'S HEALTH CENTER
050376 LAC/HARBOR-UCLA MED CENTER

Office Location

Street Address 2021 SANTA MONICA BLVD STE 400E
City SANTA MONICA
State CA
Zip Code 90404-2103

Providers in the same location

NPI Name Taxonomy Address Enumeration
1801842943 Sean Adam Fischer Internal Medicine 2021 Santa Monica Blvd Ste 400e, Santa Monica, CA 90404-2103 2006-05-26
1538687462 Laura Beth Bittner Larose Registered Nurse 2021 Santa Monica Blvd Ste 400e, Santa Monica, CA 90404-2103 2017-08-30
1508144783 Grace Chang Student in an Organized Health Care Education/Training Program 2021 Santa Monica Blvd Ste 400e, Santa Monica, CA 90404-2103 2011-07-22

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1841763687 Crystal Monique Mckinley X Counselor 1865 9th St, Santa Monica, CA 90404 2019-01-04
1952872749 Cesar O Munoz Counselor 1865 9th St., Santa Monica, CA 90404 2018-12-06
1023596574 Joseph J Pinzone Md Inc Internal Medicine 2001 Santa Monica Blvd Ste 1190, Santa Monica, CA 90404 2018-08-06
1548763535 Alan Rubenstein Dds Inc Dentist 1260 15th St., #703, Santa Monica, CA 90404 2018-03-15
1669993382 Aaron Wilson Counselor 1453 16th Street, Santa Monica, CA 90404 2017-07-03
1922472471 Chianni Lin Acupuncturist 2222 Santa Monica Blvd, Ste. 105, Santa Monica, CA 90404 2015-11-20
1467823278 Alexandra Daniela Arroyo Behavior Analyst 1838 22nd St Apt 2, Santa Monica, CA 90404 2015-10-20
1720498504 Alan Jeff Baldrias Nurse Practitioner 3300 East South St. # 203, Long Beach, CA 90404 2014-05-02
1598185647 Matthew Mcadams Rehabilitation Practitioner 1453 16th St., Santa Monica, CA 90404 2014-04-16
1720410061 Jennafer Diane Piccolo Francis Physician Assistant 9915 S. Santa Monica Blvd, Beverly Hills, CA 90404 2013-08-08
Find all providers in zip 90404

Taxonomy Information

Taxonomy Code 207RH0003X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine
Specialization Hematology & Oncology

Taxonomy Definition

An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered.
Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source]
- Additional Resources: http://www.osteopathic.org/certification

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1821105248 Jonathan W Simons Internal Medicine 1250 4th St, Suite 360, Santa Monica, CA 90401-1366 2006-08-23
1407880891 Thompson Adams Internal Medicine 2336 Santa Monica Blvd Ste 301, Santa Monica, CA 90404-2067 2006-07-10
1750322566 Sarcoma Oncology Center Internal Medicine 2811 Wilshire Blvd., Suite 414, Santa Monica, CA 90403 2006-06-10
1205877958 Sant P. Chawla M.d. Inc. Internal Medicine 2811 Wilshire Blvd. Suite #414, Santa Monica, CA 90403 2006-06-10
1801842943 Sean Adam Fischer Internal Medicine 2021 Santa Monica Blvd Ste 400e, Santa Monica, CA 90404-2103 2006-05-26
1932336211 Ucla Hematology and Oncology, Santa Monica Internal Medicine 2020 Santa Monica Blvd, Suite 600, Santa Monica, CA 90404-2023 2009-06-15
1205079373 Andrae Lavon Vandross Internal Medicine 2020 Santa Monica Blvd Ste 600, Santa Monica, CA 90404-2131 2009-04-19
1033236765 Calvin Robert Klein Internal Medicine 2336 Santa Monica Blvd, Suite 301, Santa Monica, CA 90404-2095 2007-03-26
1639271646 Steven J Tucker Internal Medicine 2001 Santa Monica Blvd, Suite 560w, Santa Monica, CA 90404-2102 2006-09-01
1841306743 Olga M Olevsky Internal Medicine 2001 Santa Monica Blvd, Suite 560w, Santa Monica, CA 90404-2102 2006-08-22
Find all providers in SANTA MONICA

Competitor

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City SANTA MONICA
Zip Code 90404

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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