Healthcare Provider Details

I. General information

NPI: 1689041212
Provider Name (Legal Business Name): KELLI M. HIRAOKA FNP-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14111 VAN NESS AVE STE 2
GARDENA CA
90249-2944
US

IV. Provider business mailing address

121 S LONG BEACH BLVD
COMPTON CA
90221-3423
US

V. Phone/Fax

Practice location:
  • Phone: 310-516-9152
  • Fax: 310-329-2121
Mailing address:
  • Phone: 310-627-5850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95019659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: