Kristofer Kisner

Primary specialty

Other Specialist/TechnologistTaxonomy code 246Z00000X

Practice address

119 W Sulphur St
Ste. B-2
Lake Elsinore, CA 92530-3703

Phone

(951) 454-2673

Fax

(951) 344-1749

NPI assigned

Apr 28, 2011

Last updated

May 18, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Inland Empire Diagnostics Inc

  • Durable Medical Equipment & Medical Supplies
  • Palm Desert, CA
  • NPI 1205127941

  Specialist/Technologist, Other

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1303948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431907200000",
    "number": "1477844116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 W SULPHUR ST",
            "address_2": "STE. B-2",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925303703",
            "telephone_number": "951-454-2673",
            "fax_number": "951-344-1749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 W SULPHUR ST",
            "address_2": "STE. B-2",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925303703",
            "telephone_number": "951-454-2673",
            "fax_number": "951-344-1749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISNER",
        "first_name": "KRISTOFER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-04-28",
        "last_updated": "2015-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246Z00000X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKCOMP",
            "identifier": "201418017",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sun Kim, PHARM D
• Timothy Joseph Kimble, D.C., F.A.C.O.
• Kingswork Solutions LLC
• Johnson K Kinyua
• Peter John Kiriakos III
• Lisa Kline
• Robert John Klopp, P.T.
• Koinonia Foster Homes Inc
• Julie Koo, ASW
• Yoshitaka Dan Koyasu, DPT

• Other Specialist/Technologist in Lake Elsinore, CA
• Providers in Lake Elsinore, CA by specialty
• Other Specialist/Technologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.