Healthcare Provider Details

I. General information

NPI: 1093663668
Provider Name (Legal Business Name): KT PSYCHOLOGY GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N STATE COLLEGE BLVD STE 1100
ORANGE CA
92868-1625
US

IV. Provider business mailing address

8235 ROCHESTER AVE STE 110
RANCHO CUCAMONGA CA
91730-0719
US

V. Phone/Fax

Practice location:
  • Phone: 949-866-3392
  • Fax:
Mailing address:
  • Phone: 949-866-3392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: KRYSTIANNA NGUYEN
Title or Position: PRESIDENT
Credential: PH. D.
Phone: 949-866-3392