Provider Demographics
NPI:1386746477
Name:KRALL, VICTOR GREGORY (DPM)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:GREGORY
Last Name:KRALL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3528 TORRANCE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4826
Mailing Address - Country:US
Mailing Address - Phone:310-539-6120
Mailing Address - Fax:
Practice Address - Street 1:3528 TORRANCE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4826
Practice Address - Country:US
Practice Address - Phone:310-539-6120
Practice Address - Fax:310-539-6120
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4033213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU65389Medicare UPIN
CAE4033BMedicare ID - Type UnspecifiedPROVIDER NUMBER