Provider Demographics
NPI:1720289309
Name:TOGUN, KRISTOFER LEONARD
Entity Type:Individual
Prefix:MR
First Name:KRISTOFER
Middle Name:LEONARD
Last Name:TOGUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 NORTHGATE BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-1348
Mailing Address - Country:US
Mailing Address - Phone:916-868-7327
Mailing Address - Fax:
Practice Address - Street 1:24321 COUNTY RD 96
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95617
Practice Address - Country:US
Practice Address - Phone:530-753-1653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health