Provider Demographics
NPI:1407518194
Name:ALLEN, KORAL (NMD)
Entity type:Individual
Prefix:
First Name:KORAL
Middle Name:
Last Name:ALLEN
Suffix:
Gender:
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 E ABRAHAM LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-6108
Mailing Address - Country:US
Mailing Address - Phone:805-574-9717
Mailing Address - Fax:
Practice Address - Street 1:2905 W WARNER RD STE 25
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-1674
Practice Address - Country:US
Practice Address - Phone:480-752-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-10
Last Update Date:2025-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21-1686175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath