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General NPI Number Information
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NPI Number | 1184988008
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Entity Type | Individual
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Provider Name | KELLY MEAD GAUGHEN D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/25/2012
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 20101 LAKE CHABOT RD FL 3
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-5305
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Country | US
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Telephone | 510-886-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 325 DISTEL CIR
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City | LOS ALTOS
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State | CA
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Zip | 94022-1408
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Country | US
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Telephone | 510-886-3400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | AC3890313-T050
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 20A22401
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036.137326
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 34.012728
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License Number State | OH
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