Healthcare Provider Details

I. General information

NPI: 1912120932
Provider Name (Legal Business Name): CHRISTINE CHAI KELLY RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1569 SLOAT BLVD SUITE 333
SAN FRANCISCO CA
94132-1256
US

IV. Provider business mailing address

1569 SLOAT BLVD STE 333
SAN FRANCISCO CA
94132-1255
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-9339
  • Fax: 415-353-3450
Mailing address:
  • Phone: 415-353-9339
  • Fax: 415-353-3450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN574014
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: