Healthcare Provider Details

I. General information

NPI: 1457096802
Provider Name (Legal Business Name): KELLY HABIB MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2022
Last Update Date: 11/02/2026
Certification Date: 11/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S LOS ROBLES AVE
PASADENA CA
91101-2441
US

IV. Provider business mailing address

3100 OAK RD STE 270
WALNUT CREEK CA
94597-2078
US

V. Phone/Fax

Practice location:
  • Phone: 833-277-0071
  • Fax: 925-944-9709
Mailing address:
  • Phone: 925-944-9711
  • Fax: 925-944-9709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA207740
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR79495
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: