MEDICARE: KELLI M. HIRAOKA FNP-BC, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95019659	CA

General Provider Information

NPI Number	:	1689041212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI M. HIRAOKA FNP-BC, RN

Provider Business Mailing Address
First Line	:	121 S LONG BEACH BLVD
Second Line	:
City	:	COMPTON
State	:	CA
Zip	:	90221-3423
Country	:	US
Telephone Number	:	310-627-5850
Fax Number	:

Provider Business Practice Location Address
First Line	:	14111 VAN NESS AVE STE 2
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90249-2944
Country	:	US
Telephone Number	:	310-516-9152
Fax Number	:	310-329-2121

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2015
Last Update Date	:	07/22/2025

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