Healthcare Provider Details

I. General information

NPI: 1659530822
Provider Name (Legal Business Name): KELLEY I-KAI CHUANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 12/14/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 E 31ST ST # 22134
OAKLAND CA
94602-1018
US

IV. Provider business mailing address

1411 E 31ST ST # 22134
OAKLAND CA
94602-1018
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-4089
  • Fax: 510-437-5127
Mailing address:
  • Phone: 510-437-4089
  • Fax: 510-437-5127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA97093
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: