Healthcare Provider Details

I. General information

NPI: 1972067957
Provider Name (Legal Business Name): CHRISTINE KHUAT NMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13430 N SCOTTSDALE RD STE 200
SCOTTSDALE AZ
85254-4058
US

IV. Provider business mailing address

15333 N HAYDEN RD UNIT 4450
SCOTTSDALE AZ
85260-3093
US

V. Phone/Fax

Practice location:
  • Phone: 888-407-7928
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19-1765
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: