Basic Information
Provider Information
NPI: 1043773518
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NGUYEN
FirstName: KRISTY
MiddleName:  
NamePrefix:  
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Credential:  
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Mailing Information
Address1: 1450 TREAT BLVD # 300
Address2:  
City: WALNUT CREEK
State: CA
PostalCode: 945972168
CountryCode: US
TelephoneNumber: 9259522828
FaxNumber:  
Practice Location
Address1: 2700 GRANT ST STE 200
Address2:  
City: CONCORD
State: CA
PostalCode: 945202270
CountryCode: US
TelephoneNumber: 9259522828
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/10/2019
LastUpdateDate: 08/23/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
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AuthorizedOfficialCredential:  
NPICertificationDate: 08/23/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000XA181007CAY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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