Provider Demographics
NPI:1730807769
Name:UKEN, CRYSTAL L (NP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:L
Last Name:UKEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4014 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-1739
Mailing Address - Country:US
Mailing Address - Phone:415-260-5455
Mailing Address - Fax:
Practice Address - Street 1:150 GOLDEN GATE AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-3810
Practice Address - Country:US
Practice Address - Phone:415-241-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2023-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019845363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily