Healthcare Provider Details

I. General information

NPI: 1730807769
Provider Name (Legal Business Name): CRYSTAL L UKEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 04/22/2023
Certification Date: 04/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 GOLDEN GATE AVE
SAN FRANCISCO CA
94102-3810
US

IV. Provider business mailing address

4014 WALNUT ST
OAKLAND CA
94619-1739
US

V. Phone/Fax

Practice location:
  • Phone: 415-241-2600
  • Fax:
Mailing address:
  • Phone: 415-260-5455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95019845
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: