Individual provider Active NPI

Kristopher Dane Howalt, MD

  • Addiction Medicine (Internal Medicine) Physician
  • Canoga Park, CA
National Provider Identifier
1962511162
Registry record updated Oct 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X
License
G62030 Issued in CA
Practice address
7246 Remmet Ave
Canoga Park, CA 91303-1531
Phone
(805) 459-2250
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X G62030 CA
Addiction Medicine (Internal Medicine) Physician 207RA0401X G62030 CA Primary

Addresses

Primary practice location

7246 Remmet Ave
Canoga Park, CA 91303-1531

Mailing address

7246 Remmet Ave
Canoga Park, CA 91303-1531
Phone (805) 459-2250

Other names 1

  • K Dane Hawalt Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100924000600 CA Practitioner - Internal Medicine 9234023391 Practice locations: San Luis Obispo, CA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G62030CAMDAddiction Medicine (Internal Medicine) Physician

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476835200000",
    "number": "1962511162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7246 REMMET AVE",
            "city": "CANOGA PARK",
            "state": "CA",
            "postal_code": "913031531",
            "telephone_number": "805-459-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7246 REMMET AVE",
            "city": "CANOGA PARK",
            "state": "CA",
            "postal_code": "913031531",
            "telephone_number": "805-459-2250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOWALT",
        "first_name": "KRISTOPHER",
        "middle_name": "DANE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2016-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G62030",
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "CA",
            "license": "G62030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "K",
            "last_name": "HAWALT",
            "middle_name": "DANE",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Canoga Park, CA

Sources for this page

Verify at the official NPI Registry.