1003337908 NPI number — KRISTOPHER WARD RANDALL DO, MPH

Table of content: KRISTOPHER WARD RANDALL DO, MPH (NPI 1003337908)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003337908 NPI number — KRISTOPHER WARD RANDALL DO, MPH

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
RANDALL

Provider First Name:
KRISTOPHER

Provider Middle Name:
WARD

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:
DO, MPH

Provider Gender Code:
M

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:
1003337908

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
05/29/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
NAVAL FAMILY BRANCH HEALTH CLINIC

Provider Second Line Business Mailing Address:
1 CHOME MISUMIMACHI

Provider Business Mailing Address City Name:
IWAKUNI

Provider Business Mailing Address State Name:
YAMAGUCHI

Provider Business Mailing Address Postal Code:
96310

Provider Business Mailing Address Country Code:
JP

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NAVAL FAMILY BRANCH HEALTH CLINIC

Provider Second Line Business Practice Location Address:
1 CHOME MISUMIMACHI

Provider Business Practice Location Address City Name:
IWAKUNI

Provider Business Practice Location Address State Name:
YAMAGUCHI

Provider Business Practice Location Address Postal Code:
96310

Provider Business Practice Location Address Country Code:
JP

Provider Business Practice Location Address Telephone Number:
82-794-8000

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:
06/29/2017

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: 2083A0100X , with the licence number: 0102205353 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .