Provider Demographics
NPI:1962402941
Name:KRAMER, JON (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:KRAMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 ROSE DR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-2026
Mailing Address - Country:US
Mailing Address - Phone:714-577-6677
Mailing Address - Fax:714-577-6625
Practice Address - Street 1:4300 ROSE DR
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-2026
Practice Address - Country:US
Practice Address - Phone:714-528-4211
Practice Address - Fax:714-579-6868
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG54187207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA52670Medicare UPIN
CAWG54187GMedicare PIN