Provider Demographics
NPI:1104298736
Name:DAHLIN, KRISTINA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:
Last Name:DAHLIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 S LA CIENEGA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-4600
Mailing Address - Country:US
Mailing Address - Phone:310-836-2273
Mailing Address - Fax:
Practice Address - Street 1:1835 S LA CIENEGA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-4600
Practice Address - Country:US
Practice Address - Phone:310-836-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52944363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical