Individual
DR. KELLY MAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1205 E NORTH ST, MANTECA, CA 95336-4932
(209) 612-9077
(209) 824-0754
Mailing address
PO BOX 993, MANTECA, CA 95336-1139
(209) 612-9077
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
G065156
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G065156
MEDICAL LICENSE NUMBER
CA
05
—
GR0045320
—
CA
Enumeration date
08/30/2006
Last updated
03/07/2023
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