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General NPI Number Information
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NPI Number | 1851822811
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Entity Type | Individual
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Provider Name | KELLY COLLON MD
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Gender | Female
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Dates
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Enumeration Date | 03/22/2017
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Last Update Date | 12/14/2021
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Provider Practice Location Address
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Address Line | DEPT OF PEDIATRICS KP WLA 5971 VENICE BLVD.
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City | LOS ANGELES
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State | CA
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Zip | 90034
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Country | US
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Telephone | 323-857-3907
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Fax |
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Provider Business Mailing Address
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Address Line | DEPT OF PEDIATRICS KP WLA 5971 VENICE BLVD.
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City | LOS ANGELES
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State | CA
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Zip | 90034
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Country | US
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Telephone | 310-825-4128
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A160000
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License Number State | CA
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