Provider Demographics
NPI:1992021596
Name:WENDORF, KRISTEN A (MD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:A
Last Name:WENDORF
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 MARINA BAY PARKWAY
Mailing Address - Street 2:BUILDING P, 2ND FLOOR
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-6403
Mailing Address - Country:US
Mailing Address - Phone:847-571-6201
Mailing Address - Fax:
Practice Address - Street 1:850 MARINA BAY PARKWAY
Practice Address - Street 2:BUILDING P, 2ND FLOOR
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-6403
Practice Address - Country:US
Practice Address - Phone:847-571-6201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA118440208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics