Healthcare Provider Details

I. General information

NPI: 1477565356
Provider Name (Legal Business Name): AARON CHRISTOPHER KISSEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: AARON CHRISTOPHER KISSEL M.D.

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32938 ROAD 222 SUITE 2
NORTH FORK CA
93643-9562
US

IV. Provider business mailing address

2740 HERNDON AVE
CLOVIS CA
93611-6813
US

V. Phone/Fax

Practice location:
  • Phone: 559-877-4676
  • Fax: 559-877-7788
Mailing address:
  • Phone: 559-299-2608
  • Fax: 559-299-1341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA065462
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: