Provider Demographics
NPI:1447479597
Name:NGUYEN, KRYSTINE TOTRAM (NMD, MPH, RD)
Entity type:Individual
Prefix:DR
First Name:KRYSTINE
Middle Name:TOTRAM
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:NMD, MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2134 E BROADWAY RD
Mailing Address - Street 2:UNIT 2016
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1773
Mailing Address - Country:US
Mailing Address - Phone:818-970-9608
Mailing Address - Fax:
Practice Address - Street 1:8841 E BELL RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1591
Practice Address - Country:US
Practice Address - Phone:480-240-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA943685133V00000X
AZ12-1348175F00000X
CAND-557175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA943685OtherCDR
AZ12-1348OtherNATUROPATHIC PHYSICIANS MEDICAL GROUP
CAND-557OtherNATUROPATHIC MEDICINE COMMITTEE