Healthcare Provider Details

I. General information

NPI: 1104865286
Provider Name (Legal Business Name): KELLY T. HOOD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 DEWING AVE SUITE 301
LAFAYETTE CA
94549
US

IV. Provider business mailing address

970 DEWING SUITE 301
LAFAYETTE CA
94549
US

V. Phone/Fax

Practice location:
  • Phone: 925-283-5500
  • Fax: 415-723-7120
Mailing address:
  • Phone: 925-283-5500
  • Fax: 415-723-7120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberC50468
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: