Provider Demographics
NPI:1942219225
Name:KRONSON, JEFFREY WARREN (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:WARREN
Last Name:KRONSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W HUNTINGTON DR STE 519
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-1512
Mailing Address - Country:US
Mailing Address - Phone:626-254-2287
Mailing Address - Fax:626-254-2289
Practice Address - Street 1:301 W HUNTINGTON DR STE 519
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-1512
Practice Address - Country:US
Practice Address - Phone:626-254-2287
Practice Address - Fax:626-254-2289
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA530232086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH27916Medicare UPIN
CAA53023Medicare ID - Type Unspecified