Healthcare Provider Details

I. General information

NPI: 1164866034
Provider Name (Legal Business Name): KELLY EGAN HUIBREGTSE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY RENEE EGAN M.D.

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 RHODE ISLAND ST
SAN FRANCISCO CA
94103-5182
US

IV. Provider business mailing address

PO BOX 276950
SACRAMENTO CA
95827-6950
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-5411
  • Fax:
Mailing address:
  • Phone: 415-600-5411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA135616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: