Provider Demographics
NPI:1528674017
Name:AKUNE, CRYSTAL KIM (NP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:KIM
Last Name:AKUNE
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 1:900 E WASHINGTON ST STE 301
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-8182
Mailing Address - Country:US
Mailing Address - Phone:559-940-4710
Mailing Address - Fax:
Practice Address - Street 1:900 E WASHINGTON ST STE 301
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-8182
Practice Address - Country:US
Practice Address - Phone:909-370-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-20
Last Update Date:2024-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015248363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner