Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0007X | Plastic Surgeon (Head & Neck) | A116470 | CA |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | A116470 | CA |
NPI | 1932397007 |
---|---|
Provider Name | Dr. Kristina Tansavatdi |
First Address | Westlake Village, CA 91361-4456 |
Second Address | Westlake Village, CA 91361-4456 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2007 |
Last Update Date | 20/09/2021 |