Provider Demographics
NPI:1699111807
Name:ROUX, KRISTEN YVETTE FONG (NP)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:YVETTE FONG
Last Name:ROUX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:YVETTE
Other - Last Name:FONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:2238 GEARY BLVD # 8SE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3416
Mailing Address - Country:US
Mailing Address - Phone:415-833-7988
Mailing Address - Fax:415-833-8530
Practice Address - Street 1:2238 GEARY BLVD # 8SE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3416
Practice Address - Country:US
Practice Address - Phone:415-833-7988
Practice Address - Fax:415-833-8530
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20082363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology