Healthcare Provider Details

I. General information

NPI: 1851822811
Provider Name (Legal Business Name): KELLY COLLON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY SCHERMER

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPT OF PEDIATRICS KP WLA 5971 VENICE BLVD.
LOS ANGELES CA
90034
US

IV. Provider business mailing address

DEPT OF PEDIATRICS KP WLA 5971 VENICE BLVD.
LOS ANGELES CA
90034
US

V. Phone/Fax

Practice location:
  • Phone: 323-857-3907
  • Fax:
Mailing address:
  • Phone: 310-825-4128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA160000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: