Provider Demographics
NPI:1265015374
Name:SIDHU, KRISTINE MARIE ALLAN (MSC)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:MARIE ALLAN
Last Name:SIDHU
Suffix:
Gender:F
Credentials:MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 OLD CHESTERBROOK RD
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4739
Mailing Address - Country:US
Mailing Address - Phone:949-300-0017
Mailing Address - Fax:
Practice Address - Street 1:201 INDUSTRIAL RD
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-2396
Practice Address - Country:US
Practice Address - Phone:650-249-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0139000188170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS