Healthcare Provider Details

I. General information

NPI: 1740505817
Provider Name (Legal Business Name): KELLY OKAZAKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RONAL REGAN MEDICAL CTR 757 WESTWOOD PLAZA SUITE 3304
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

1615 N SILVERWOOD ST
ORANGE CA
92867-3861
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-8041
  • Fax:
Mailing address:
  • Phone: 714-292-3711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: