Healthcare Provider Details

I. General information

NPI: 1831476779
Provider Name (Legal Business Name): KASINEE WILLIAMS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2011
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 NORTH PECK RD
EL MONTE CA
91733
US

IV. Provider business mailing address

811 E EMERSON AVE
MONTEREY PARK CA
91755-2009
US

V. Phone/Fax

Practice location:
  • Phone: 626-350-2196
  • Fax:
Mailing address:
  • Phone: 626-679-0373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: