Provider Demographics
NPI:1699707265
Name:REID, KRISTEN W (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:W
Last Name:REID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:WOOD-REID
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1180 BRIARCLIFF PL NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-4832
Mailing Address - Country:US
Mailing Address - Phone:415-505-7335
Mailing Address - Fax:
Practice Address - Street 1:1364 SFGH BLDG 10
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0001
Practice Address - Country:US
Practice Address - Phone:415-206-5141
Practice Address - Fax:415-206-5586
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82258207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A822580Medicaid
CA00A822580Medicaid
CA00A822580Medicare PIN