Healthcare Provider Details

I. General information

NPI: 1831010305
Provider Name (Legal Business Name): KELAINNE KAINA JOSEPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 55TH ST
SAN DIEGO CA
92105-5043
US

IV. Provider business mailing address

9027 WESTMORE RD
SAN DIEGO CA
92126-2405
US

V. Phone/Fax

Practice location:
  • Phone: 619-493-0077
  • Fax:
Mailing address:
  • Phone: 619-802-5951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License NumberY9095333
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: