Provider Demographics
NPI:1619337961
Name:NGUYEN, KRISTY DOAN (MD)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:DOAN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 NW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1068
Mailing Address - Country:US
Mailing Address - Phone:405-272-7452
Mailing Address - Fax:405-272-7455
Practice Address - Street 1:608 NW 9TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1068
Practice Address - Country:US
Practice Address - Phone:405-272-7452
Practice Address - Fax:405-272-7455
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK38359208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program