Provider Demographics
NPI:1124552880
Name:BETZ, KJIRSTEN AYN CARLSON (MD)
Entity type:Individual
Prefix:
First Name:KJIRSTEN AYN CARLSON
Middle Name:
Last Name:BETZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KJIRSTEN
Other - Middle Name:
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 276950
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-6950
Mailing Address - Country:US
Mailing Address - Phone:415-600-1817
Mailing Address - Fax:415-369-1369
Practice Address - Street 1:2351 CLAY ST STE 512
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1931
Practice Address - Country:US
Practice Address - Phone:415-600-1817
Practice Address - Fax:415-369-1369
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA147052208600000X, 2086X0206X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery