1447479597 NPI number — DR. KRYSTINE TOTRAM NGUYEN N.M.D., M.P.H, R.D.

Table of content: JESSICA NICOLE LINDEN (NPI 1023680311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447479597 NPI number — DR. KRYSTINE TOTRAM NGUYEN N.M.D., M.P.H, R.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NGUYEN
Provider First Name:
KRYSTINE
Provider Middle Name:
TOTRAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
N.M.D., M.P.H, R.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447479597
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2134 E BROADWAY RD
Provider Second Line Business Mailing Address:
UNIT 2016
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85282-1773
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-970-9608
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8841 E BELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85260-1591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-240-2600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  943685 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175F00000X , with the licence number: 12-1348 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 175F00000X , with the licence number: ND-557 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 943685 . This is a "CDR" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 12-1348 . This is a "NATUROPATHIC PHYSICIANS MEDICAL GROUP" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: ND-557 . This is a "NATUROPATHIC MEDICINE COMMITTEE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".