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General NPI Number Information
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NPI Number | 1689041212
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Entity Type | Individual
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Provider Name | KELLI M. HIRAOKA FNP-BC, RN
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Gender | Female
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Dates
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Enumeration Date | 08/31/2015
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 14111 VAN NESS AVE STE 2
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City | GARDENA
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State | CA
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Zip | 90249-2944
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Country | US
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Telephone | 310-516-9152
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Fax | 310-329-2121
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Provider Business Mailing Address
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Address Line | 121 S LONG BEACH BLVD
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City | COMPTON
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State | CA
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Zip | 90221-3423
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Country | US
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Telephone | 310-627-5850
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95019659
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License Number State | CA
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