Healthcare Provider Details

I. General information

NPI: 1174056402
Provider Name (Legal Business Name): KAYLEE RAE PARSONS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLEE RAE KENYON D.O.

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12665 GARDEN GROVE BLVD STE 713
GARDEN GROVE CA
92843-1921
US

IV. Provider business mailing address

11234 ANDERSON ST GME OFFICE WESTERLY SUITE 'C'
LOMA LINDA CA
92354-2804
US

V. Phone/Fax

Practice location:
  • Phone: 714-542-1331
  • Fax:
Mailing address:
  • Phone: 909-558-4174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A16740
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: