Individual
KRIS J. VAN LOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9898 GENESEE AVE, LA JOLLA, CA 92037-1205
(858) 626-7275
(858) 626-4085
Mailing address
10790 RANCHO BERNARDO RD, SAN DIEGO, CA 92127-5705
(858) 626-7275
(858) 626-4085
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G56641
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G566410
—
CA
Enumeration date
05/12/2006
Last updated
07/18/2019
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