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Individual
KELLIE KODAMA
Active
Individual
KELLIE KODAMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
11685
AZ
363A00000X
Physician Assistant
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
224710
—
AZ
Enumeration date
09/29/2022
Last updated
06/01/2026
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